Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India

Vassall, Anna; Pickles, Michael; Chandrashekar, Sudha; Boily, Marie‐Claude; Shetty, Govindraj; Guinness, Lorna; Lowndes, Catherine M; Bradley, Janet; Moses, Stephen; Alary, Michel; Vickerman, Peter

doi:10.1016/s2214-109x(14)70277-3

Cited by 41 publications

(31 citation statements)

References 21 publications

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“…More generally, our results highlight the importance of high risk groups and targeted HIV prevention for high-groups. Indeed, such targeted preventions have been shown to be highly cost-effective 51,73 .…”

Section: Discussionmentioning

confidence: 99%

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Maheu‐Giroux

Vesga

Diabaté

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction Understanding the impact of past interventions and how it affected transmission dynamics is key to guiding prevention efforts. We estimated the population-level impact of condom, antiretroviral therapy (ART), and prevention of mother-to-child transmission activities on HIV transmission and the contribution of key risk factors on HIV acquisition and transmission. Methods An age stratified dynamical model of sexual and vertical HIV transmission among the general population, female sex workers (FSW), and men who have sex with men (MSM) was calibrated to detailed prevalence and intervention data. We estimated the fraction of HIV infections averted by the interventions, and the fraction of incident infections acquired and transmitted by different populations over successive 10-year periods (1976-2015). Results Overall, condom use averted 61% (95% Credible Intervals: 56-66%) of all adult infections during 1987-2015 mainly due to increases by FSW (46% of infections averted). In comparison, ART prevented 15% (10-19%) of adult infections during 2010-2015. As a result, FSW initially (1976-1985) contributed 95% (91-97%) of all new infections, declining to 19% (11-27%) during 2005-2015. Older men and clients mixing with non-FSW are currently the highest contributor to transmission. MSM contributed ≤4% of transmission throughout. Young women (15-24 years; excluding FSW) did not transmit more infection than they acquired. Conclusion Early increases in condom use, mainly by FSW, have substantially reduced HIV transmission. Clients of FSW and older men have become the main source of transmission whereas young women remain at increased risk. Strengthening prevention and scaling-up of ART, particularly to FSW and CFSW, is important.

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Section: Discussionmentioning

confidence: 99%

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Maheu‐Giroux

Vesga

Diabaté

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Another study examining HIV-infected IDUs in the United States reported risk-reduction and health promotion programs had cost-effectiveness ratios ranging from $7,707 to $24,072/QALY gained [15]. In India, the comprehensive Avahan program for FSWs, which includes condom distribution, peer outreach, education, and treatment of sexually transmitted infections (STIs), had a mean ICER of $46/DALY averted at an incremental cost of $785/HIV infection averted when assessed at scale in 22 districts [16]. Adding community mobilization and empowerment to the program came at an incremental cost of approximately $14/DALY averted [17].…”

Section: Hiv Prevention Interventionsmentioning

confidence: 99%

Modeling and Cost-Effectiveness in HIV Prevention

Jacobsen

Walensky

2016

Curr HIV/AIDS Rep

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With HIV funding plateauing and the number of people living with HIV increasing due to the roll-out of life-saving antiretroviral therapy, policy makers are faced with increasingly tighter budgets to manage the ongoing HIV epidemic. Cost-effectiveness and modeling analyses can help determine which HIV interventions may be of best value. Incidence remains remarkably high in certain populations and countries, making prevention key to controlling the spread of HIV. This paper briefly reviews concepts in modeling and cost-effectiveness methodology, then examines results of recently published cost-effectiveness analyses on the following HIV prevention strategies: condoms and circumcision, behavioral or community-based interventions, prevention of mother to child transmission, HIV testing, pre-exposure prophylaxis, and treatment as prevention. We find that the majority of published studies demonstrate cost-effectiveness; however, not all interventions are affordable. We urge continued research on combination strategies and methodologies that take into account willingness to pay and budgetary impact.

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“…The UNAIDS strategic investment framework for an effective response to human immunodeficiency virus (HIV)/AIDS proposes the scale‐up of HIV prevention for key populations as one of its core interventions (Schwartländer et al, ). This prioritisation is supported by strong evidence of the cost‐effectiveness of HIV prevention to key populations (Vassall et al, ). However, resources to expand HIV prevention to all who may benefit from it remain scarce.…”

Section: Introductionmentioning

confidence: 99%

What Determines HIV Prevention Costs at Scale? Evidence from the Avahan Programme in India

et al. 2016

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Expanding essential health services through non‐government organisations (NGOs) is a central strategy for achieving universal health coverage in many low‐income and middle‐income countries. Human immunodeficiency virus (HIV) prevention services for key populations are commonly delivered through NGOs and have been demonstrated to be cost‐effective and of substantial global public health importance. However, funding for HIV prevention remains scarce, and there are growing calls internationally to improve the efficiency of HIV prevention programmes as a key strategy to reach global HIV targets. To date, there is limited evidence on the determinants of costs of HIV prevention delivered through NGOs; and thus, policymakers have little guidance in how best to design programmes that are both effective and efficient. We collected economic costs from the Indian Avahan initiative, the largest HIV prevention project conducted globally, during the first 4 years of its implementation. We use a fixed‐effect panel estimator and a random‐intercept model to investigate the determinants of average cost. We find that programme design choices such as NGO scale, the extent of community involvement, the way in which support is offered to NGOs and how clinical services are organised substantially impact average cost in a grant‐based payment setting. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

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Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India

Abstract: Bill & Melinda Gates Foundation.

Cited by 41 publications

References 21 publications

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Modeling and Cost-Effectiveness in HIV Prevention

What Determines HIV Prevention Costs at Scale? Evidence from the Avahan Programme in India

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