J. Hung, A. Smith
The global ambition to end the human immunodeficiency virus (HIV) epidemic requires understanding which system-level policy levers, enacted under the framework of Universal Health Coverage (UHC), are most effective in achieving both transmission reduction and increasing access to diagnosis and treatment. This study addresses an important evidence gap by quantifying the within-country association between measurable UHC policy indicators and the estimated rate of new HIV infections across nine Southeast Asian countries between 2013 and 2022. Employing a Fixed-Effects panel data methodology, the analysis controls for time-invariant national heterogeneity, so that the estimates describe change over time within each country. We found that within-country changes over time in total current health expenditure (CHE) as a percentage of gross domestic product (GDP) were not statistically significantly associated with the estimated rate of new HIV infections. However, increases in the UHC Infectious Disease Service Coverage Index were statistically significantly associated with concurrent reductions in HIV incidence (p < 0.001), suggesting that targeted, disease-specific service delivery is the most consistent of the policy levers we examined. In addition, the UHC Reproductive, Maternal, Newborn, and Child Health Service Coverage Index exhibited a statistically significant positive association with HIV incidence (p < 0.01). We cannot determine whether this positive association indicates improved detection of previously undiagnosed cases, a feature of how UNAIDS estimates incidence, or the influence of the wider sexual and reproductive health system. Furthermore, out-of-pocket (OOP) health expenditure as a percentage of CHE showed a counterintuitive negative association with the estimated rate of new HIV infections (p < 0.01). Because this metric measures spending across the whole health system, further research at the individual level is needed before this finding can inform policy. These findings suggest that domestic HIV policymakers should prioritise targeted investment in infectious disease services over aggregate fiscal commitment.