Sustaining the HIV Response: Inclusion of HIV Treatment in Social Health Insurance in the Dominican Republic

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The global reduction in antiretroviral (ARV) drug prices and other advances over the past decade have transformed HIV from a life-threatening pandemic to a manageable chronic condition. Adherence to antiretroviral treatment (ART) can allow people living with HIV (PLHIV) to live with little to no risk of transmitting the HIV, but they must have continual access to affordable treatment. Since 2015, the Dominican government has approved a national budget to purchase enough ARV drugs for its PLHIV, but there is no guarantee that future governments will continue to prioritize the allocation of sufficient funding as more people become eligible for treatment.

Aiming to guarantee sustainable financing for ART, the Dominican government committed in the 2015–2018 National Strategic Plan to cover ART within the Family Health Insurance (SFS) scheme. This would ensure that regular social insurance contributions by employees, employers, and the government can be used to finance affordable treatment for the enrolled population as long as needed. The National HIV and AIDS Council (CONAVIHSIDA) and the Superintendence of Health and Labor Risks (SISALRIL) were tasked with implementing this directive but confronted a challenge: ARVs are purchased internationally in one annual order to reduce costs, and SFS’s decentralized design does not cover drugs or supplies purchased centrally from foreign suppliers.

To tackle this issue, USAID’s Health Financing and Governance Project (HFG) provided technical assistance to CONAVIHSIDA and SISALRIL to develop an operational model that identifies the institutional reforms required for allowing ARVs to be financed through the SFS while still being purchased centrally at international level by the government and delineates the steps required to implement the model. HFG prepared the proposed model for review and consideration by the Minister of Health and the National Social Security Council.

Additionally, in preparation for the inclusion of ARVs in the social insurance scheme, we assessed the current systems for procuring, warehouse and distributing ARVs and identified laws and regulations in need of modification. Through this support, we identified over US$160,000 in potential annual cost savings that could be realized by transferring warehousing and distribution responsibilities fully to the public sector. This would in turn increase the funding available for ARV procurement and, ultimately, contribute to increased access to ARVs and reaching the 90-90-90 targets.

Finally, HFG analyzed the current information systems that would need to be improved or modified to facilitate ARV inclusion in SFS. The guide outlining these proposed changes identifies specific software and the corresponding adjustments needed to allow public and private insurance companies to monitor ARVs procured centrally for their members, while protecting personal information.

The inclusion of ART in the SFS would represent a positive commitment on the part of the Dominican Republic to ensure the sustained availability of ART, and with it, improve livelihoods of people living with HIV. HFG’s contributions towards institutional reforms are helping put this commitment into action, and moreover facilitating the sustainable expansion of the Treatment for All strategy. HFG is continuing work in the Dominican Republic to enroll people living with HIV in SFS to take advantage of this source of sustainable financing and financial protection.

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