Assessing the population health impact of market interventions to improve access to antiretroviral treatment
Despite global progress in increasing coverage of antiretroviral treatment (ART), the majority of people needing ART currently are not receiving treatment. Several international organisations are using interventions in ART markets to decrease ART price or to improve ART quality, delivery and innovation, with the ultimate goal of improving population health. These organisations need to select those market interventions that are most likely to affect population health outcomes (ex ante assessment) and to evaluate whether implemented interventions have improved health outcomes (ex post assessment).
This paper presents a framework to structure the assessment of the population health impact of ART market interventions, both for funding decisions and for empirical evaluation of impact. It describes assessment methods and their limitations and makes seven practical recommendations.
- ex ante assessment should include evaluation of the safety and efficacy of the ART products whose markets will be affected by the intervention; theoretical consideration of the mechanisms through which the intervention will affect population health; and predictive modelling to estimate the potential population health impact of the intervention.
- for ex post assessment, analysts need to consider which outcomes to estimate empirically and which to model based on empirical findings and understanding of the economic and biological mechanisms along the causal pathway from market intervention to population health.
- both ex ante and ex post assessments of the population health impact of intervening in ART markets require careful planning. Stakeholders need to decide which impacts to assess, what data to collect, which analytical approaches to use, and when and how often to evaluate impact. These decisions will depend on the type of intervention, stakeholders’ expectations of the strength of the evidence and the impartiality of the assessor, data availability, limitations of existing analytic methods and the cost of assessment.