 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Deborah A. Cohen, MD, MPH, Health, RAND Corporation, 1700 Main Street, Santa Monica, CA 90405, 310 393-0411 ext 6023, dcohen@rand.org, Shin-Yi Wu, PhD, Health, RAND, 1700 Main Street, Santa Monica, CA 90407, and Thomas A Farley, MD, MPH, Community Health Sciences, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112.
Background: The goal of HIV prevention is to prevent as many new infections as possible. Tools are needed to help local communities select the best combination of strategies to address their local epidemics. We developed a spreadsheet that allows users to compare estimates of the cost-effectiveness across a wide variety of HIV prevention strategies.
Methods: We used Bernoulli and proportionate change models to develop a spreadsheet that compares the cost-effectiveness of 25 HIV prevention strategies, including individual behavior-change, biomedical, and structural interventions. Users can input local data on the size and HIV prevalence of the target group, intervention effectiveness, and local costs. We also conducted sensitivity analyses to assess the robustness of the cost-effectiveness comparisons across different populations and using various assumptions.
Results: The most cost-effective strategies with low prevalence populations (e.g. heterosexuals) were structural interventions (e.g. mass media, condom distribution), while individual and small-group interventions were still relatively cost-effective when targeted at high prevalence populations, particularly MSM and HIV-positives. Among the most cost-effective strategies were showing videos in STD clinics and raising alcohol taxes. School based HIV prevention programs were among the least cost effective. Needle exchange and needle deregulation programs were cost effective when IDUs had a high HIV prevalence, but not where IDUs HIV prevalence is low. When other implementation factors are considered, local communities may generate different portfolios for their HIV prevention programs.
Conclusions: Comparing estimates of the cost-effectiveness of HIV interventions provides insight that helps local communities maximize the effectiveness of their HIV prevention resources.
Learning Objectives:
Keywords: HIV Interventions, Cost Issues
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.