SD.20.013 – How to arrive at sustainable healthcare in HIV-affected countries?

Route: Sustainable development goals for inclusive global development

Cluster question: 094 How do we improve the quality of health care as much as possible while keeping it affordable?

The countries hardest hit by the HIV pandemic will face massive healthcare challenges in the coming years. The tremendous success of (largely donor-funded) HIV treatment and prevention programs has resulted in many deaths averted, yet the ever growing number of people receiving lifelong HIV treatment is increasingly overburdening health systems. Financial and human resources required will further increase over the coming years, while donor funding is actually declining. People with HIV ageing due to treatment are also increasingly faced with co-morbidities such as cardiovascular diseases and cancers, with HIV as a proven risk factor. Also, demographic and epidemiological transitions are increasing the prevalence of non-communicable diseases in HIV-uninfected people, further straining scarce resources. Innovations such as community based care, self-testing, m-health, and drone-delivered medication are developing quickly and could alleviate pressure and improve accessibility, yet no guidance exists on optimal implementation.

We will innovate medical decision sciences by developing the first multi-disease individual-based mathematical model that simulates the most important diseases in the five biggest countries of Southern Africa. The subcontinent harbors 15 million HIV-infected people, nearly 40% of all cases worldwide, and we have established collaborations with policymakers in all five countries. We will introduce new components into mathematical modeling for public health, including health systems dynamics simulating individual patient contacts with providers explicitly, thus allowing for assessing the potential impact of health system innovations. Also, we will intrinsically account for current and expected future human and financial resource constraints, essential when considering feasibility and sustainability. A key-component of our approach will be co-creation to involve local implementers, policymakers, and civil society organizations throughout the project as active participants, from model development to strategy design. Finally, through participatory research, we will engage with the population to ensure that our tool optimizes resource allocation based on local values and preferences.


epidemiological transition, health economics, health systems, low- and middle-income countries, mathematical modeling, participatory research, sustainability

Other organisations

Aidsfonds (Dutch AIDS foundation), Amsterdam Institute for Global Health and Development (AIGHD), Institute for Health Sciences, Local consortium partners: National AIDS Council Malawi, Ministry of Health Malawi, Ministry of Health Mozambique, Ministry of Health South Africa, Ministry of Health Zambia, Ministry of Health Zimbabwe, National AIDS Council Mozambique, National AIDS Council Zambia, National AIDS Council Zimbabwe, Radboud Medical Center (RUMC), Royal Tropical Institute (KIT), South African National AIDS Council (SANAC), Tilburg School of Social and Behavioral Sciences, Tilburg University (TiU)


Organisation Department of Public Health, Erasmus MC (EMC)
Name Dr. J.A.C. (Jan) Hontelez