Balancing efficiency, equity and feasibility of HIV treatment in South Africa – development of programmatic guidance

Table 1 Hypothetical and simplified MCDA for HIV treatment in South Africa

HIV treatment programme option	Feasibility^†	Efficiency^†	Equity^†	Other	Total^‡
	Health system constraints	Acceptability	Costs per health gain	Fair distribution of health gains	…..
How to deliver treatment
Hospital-based treatment	••	••	••	••		••
Facility-based treatment	•••	•••	•••••	••••		••••
Mobile clinic-based treatment	•	••••	••	•••••		•••
Transport subsidies	••	••••	••	•••••		•••
When to initiate treatment
Treatment CD4 < 200 cells/μl	•••••	•••	••	••••		•••
Treatment CD4 < 350 cells/μl	•••	•••	••••	•••		•••
Universal test and treat	•	••	•••••	•		••
Who gets targeted for treatment
Discordant couples^‡‡	•••	••	•••••	••		•••
Compliant patient groups^‡‡	•••	••	•••••	•		•••
Pregnant women^‡‡	•••	••••	•••	•••		••••
Productive adults	•••	•••	•••	•		••
First-come first-serve	•••	•	••	•		••
Weights	20	20	30	30

†The performance of interventions on efficiency, equity and feasibility is hypothetical and for iIIustrative purposes only. Criteria are example criteria only. The scoring ranges from • to ••••• respectively representing a very weak to very strong performance of an intervention on a certain criteria.
‡The total is calculated as the weighted scores on all criteria and rounded-off.
‡‡Irrespective of CD4 cell count.