| Overview : The World Health Organization (WHO) estimates that the risk of developing TB is estimated to be between 26 and 31 times greater in people living with HIV than among those without HIV infection. In 2014, there were 9.6 million new cases of TB, of which 1.2 million were among people living with HIV. As of 2012, Belize has the highest overall HIV prevalence rate in Central America with an estimate of 1.4% and approximately 3,300 people living with HIV (Global AIDS Report 2013). The estimated TB prevalence is 51 per 100,000, while the incidence is 40 per 100,000. Available data consistently reveal that the Belize, Cayo and Stann Creek districts have a high burden of TB and HIV thus representing the key affected geographic areas. In efforts to fight the rising numbers of HIV and TB infections in Belize, there have been increasing budgetary requirements as well as the need for adequate management and reporting of TB- and HIV-related finance. Since sustaining TB and HIV-control at current levels and making further progress to achieve global targets requires financing, data about funding needs, sources of funding, funding gaps and expenditures are important at global, regional, national and sub-national levels. As part of its commitment to country ownership, shared responsibility and sustainable HIV/AIDS responses, UNAIDS is encouraging the application of the investment approach and the development of HIV/AIDS-TB investment cases. The investment approach is a process that all countries are encouraged to use whenever rigorous examination of the HIV/AIDS-TB response is required, to ensure optimized and sustainable HIV/AIDS-TB responses for the future; it catalyses a rigorous examination of HIV/AIDS-TB responses in terms of effectiveness, efficiency, and sustainability with a long-term outlook. Investment cases are succinct documents that are the products of applying the investment approach process. At their core is the description of returns on investment in a country’s optimized HIV/AIDS-TB response over the long term (typically 10+ years). In addition, investment cases typically: provide essential highlights on the state of the epidemic and the response; describe the prioritized interventions/populations/geographic areas to be implemented to achieve the greatest impact over the long term and the resources required; outline the main access, delivery, and quality issues to be addressed to improve HIV/AIDS-TB services and describes what will be done to address these; identify the major inefficiencies in HIV/AIDS-TB programs, quantify these and describe what will be done to improve efficiency; include an analysis of and plan for realistic and more sustainable financing of the HIV/AIDS-TB response including increases in domestic financing where relevant. Solid investment cases provide an indication of the kind of results that could be achieved if policymakers take decisions toward more strategic investment. They can contribute to discussions on increasing domestic HIV/AIDS-TB investment. They can form the basis of Global Fund funding requests and serve as a starting point for developing partnership frameworks and sustainability plans for the US President’s Plan for AIDS Relief (PEPFAR). Impact models have been developed for the Dominican Republic and Haiti since February 2015 to inform the finalization of the Investment Cases in collaboration with the Ministry of Health, UNAIDS and other key national stakeholders and global partners. One key component of the Investment Cases is the analysis of how resources are currently allocated to interventions and populations and comparison with alternative scenarios to identify the biggest potential for impact on incidence and mortality[1]. A team of national counterparts and a national consultant will lead the implementation of the Investment Case, based on in-depth analysis of quantitative and qualitative data generated to identify possible gains in resource allocation and in achieving higher levels of efficiency in the use of the available resources. Objective The objective of the consultancy is to assist national partners in Belize to assess the epidemiological impact and cost of scaling up the response to HIV/AIDS as a basis for Sustainable HIV/AIDS Finance planning. In particular, the calibration and adaptation of Belize’s epidemiological HIV curves and values and generating different scenarios of resource allocation to identify the potential for impact on incidence and mortality in the country. Belize has specific interest in the following scenarios (however, other scenarios may arise during in-country discussions): - The baseline
- Scale up to test and treat: placing a patient on treatment as soon as positive test is revealed, regardless of CD4 count
- Introduction of additional testing modalities (self-testing and community-based testing)
- Fast tracking to meet the UNAIDS 90-90-90 targets
[1] “Making the case for investing in HIV more strategically: An investment case tool”, UNAIDS August 2013 | 
