Master of Advanced Studies
in Humanitarian Logistics and Management


An Aids Free Generation in Côte d’Ivoire - E.S.

How is an AIDS-Free Generation Achievable in Côte d’Ivoire?
A Systems Dynamics Approach to Evidence-based Policy Design for HIV/AIDS Response Programs.
by Simplice Takoubo Kamdem

Problem description

Sub-Saharan Africa is the region most severely affected by the HIV/AIDS epidemic, with 24.7 million people living with HIV, out of 35 million people globally (2013 estimate). It also accounts for almost 70% of the global total of new HIV infections and about one- third of all globally known AIDS cases. In West Africa, Cote d’Ivoire has the highest HIV prevalence rate (3.7% in 2012), with the two virus types HIV-1 and HIV-2 present. From an epidemiological standpoint, these unique attributes place Cote d’Ivoire in a very different position when compared with other countries in Africa. Existing HIV/AIDS modeling policies were developed based on data from countries that do not have these peculiarities. Cote d’Ivoire has embraced the global vision of creating an AIDS-free generation. This project explores policy changes required to attain the vision of an AIDS-free generation for Cote d’Ivoire.

Approach to addressing the problem

System dynamics is defined as methodologies that help model the complexities of the real world and help understand the consequences of decisions. Using a system dynamic approach, a model is proposed in this paper to simulate future effects of policy changes on HIV/AIDS trends. The work also identifies elements that influence policy design and priority setting for an HIV response program in a low-resource environment like Cote d’Ivoire. This paper proposes a simulation model that enables both decisions makers and policy designers to test different assumptions, explore potential scenarios, and examine possible impacts of decisions considered. The model used in this thesis is based on historical data from 1990 to 2012 and projects to the year 2040.

Data used for this paper are of various types. Some are primitive data, such as those from published reports we accessed. Others are composite data, which are obtained by combining several data points to support the design of the model. The majority of historical HIV data used for this paper are widely available on international organization websites such as UNAIDS and World Bank. Complementary data are from our literature review from sources both internal and external to the Cote d’Ivoire HIV/AIDS program.


The model replicates the trend of the spread of HIV/AIDS in Cote d’Ivoire as generated by historical data from the past two decades. The findings include a behavior pattern regarding the development of HIV/AIDS over the period up to the year 2040. This simulation leads to the formulation of evidence-based policies. Based on the model, the paper explores feasible policies and recommends the ones to be adopted for higher impact. The model suggests that a single area policy like controlling the infection rate alone cannot significantly impact the number of HIV-infected individuals in the long run. Rather, the findings suggest that a combinatory approach will be more effective in achieving the vision of an AIDS-free generation. This combined approach policy is the essence of the policy tested in the scenario below (Fig.2), which is the policy that we recommend from this work, for the period starting in 2015. Under this policy, HIV infections among young people will be down to zero in 2035 only with the elimination of prenatal transmission of HIV. This result will not be attained with current policies (see Fig.1).


As an alternative policy, the model proposes to cut by half the HIV prenatal transmission, decrease infectivity among mature healthy populations by 20%, and increase the adult enrollment rate on ART by 10%. The model suggests that this policy will have a significant effect on each population category (see Fig.2).


The policy analysis above excludes the cost and budgetary components. The introduction of the costs in this model could be the costs to forecast budget requirements over time and include the cost-effectiveness dimension when comparing for the suitable policy to retain for the program.

Contribution toward addressing the problem

The present work is the first application of the system dynamics model in the description of the Cote d’Ivoire HIV epidemic. This is the first attempt to use HIV transmission data to replicate historical data in order to inform program design and realignment. The model describes the trend of the HIV epidemic in Cote d’Ivoire over the next 25 years. The trend observed in the simulations will hold if the hypotheses are verified in the future.

The goal of this project was to propose a paper that is academically relevant and at the same time meaningful and impactful in organizations as a planning tool. This model achieves this goal to an acceptable extent. It contributes to closing an existing gap in a comprehensive set of forecast data about the HIV epidemic in Cote d’Ivoire. It also aims at suggesting tools to help shape policy design and prioritize areas and pace for the investment of limited resources to gear efforts toward achieving an AIDS-free generation in Cote d’Ivoire.

This proposed model is dynamic, and refinement is possible when new and better data sets are available. It can further be improved to allow for exploring the effects of changes in the variation of risk of HIV transmission, viral load monitoring, and average time with AIDS and infectivity. Because of the dynamic nature of HIV/AIDS programs, it is recommended that assumptions be continuously revisited to assess whether results predicted by modeling exercises are occurring in practice. Future work might consider adding the cost component to the model so that it can generate budget estimates required for implementing policy scenarios. In addition, this model could be extended and adjusted to address the needs of any HIV/AIDs program, based on country-specific HIV/AIDS data.


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