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The authors declare that they have no competing interests.
All authors have made substantial contributions to the intellectual content of the paper. WZ contributed to the conception and design, acquired the data, analyzed and interpreted the data, and drafted and revised the manuscript. DSS contributed to the conception and design of the study, acquired the data, interpreted the data, and critically revised the manuscript. JC contributed to the critical revision of the manuscript for important intellectual content, and provided technical support. CA contributed to the acquisition of data, interpretation of data, obtaining funding, and providing technical support. All authors read and approved the final manuscript.
The economic downturn exacerbates the inadequacy of resources for combating the worldwide HIV/AIDS pandemic and amplifies the need to improve the efficiency of HIV/AIDS programs.
We used data envelopment analysis (DEA) to evaluate efficiency of national HIV/AIDS programs in transforming funding into services and implemented a Tobit model to identify determinants of the efficiency in 68 low- and middle-income countries. We considered the change from the lowest quartile to the average value of a variable a "notable" increase.
Overall, the average efficiency in implementing HIV/AIDS programs was moderate (49.8%). Program efficiency varied enormously among countries with means by quartile of efficiency of 13.0%, 36.4%, 54.4% and 96.5%. A country's governance, financing mechanisms, and economic and demographic characteristics influence the program efficiency. For example, if countries achieved a notable increase in "voice and accountability" (e.g., greater participation of civil society in policy making), the efficiency of their HIV/AIDS programs would increase by 40.8%. For countries in the lowest quartile of per capita gross national income (GNI), a notable increase in per capita GNI would increase the efficiency of AIDS programs by 45.0%.
There may be substantial opportunity for improving the efficiency of AIDS services, by providing more services with existing resources. Actions beyond the health sector could be important factors affecting HIV/AIDS service delivery.