142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Can an Alcohol Intervention in Kenya Deliver Favorable Value?

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 12:50 PM - 1:10 PM

R. Scott Braithwaite, MD , Department of Medicine, New York University School of Medicine, New York, NY
Kendall Bryant, PhD , National Institute on Alcohol Abuse and Alcoholism (NIAAA), Rockville, MD
Alison Galvani, PhD , School of Medecine, Yale University, New Haven, CT
Mark Roberts, MD , Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA

Alcohol leads to 13% of new HIV infections in Kenya. Randomized controlled trials of cognitive behavioral therapy (CBT)-based alcohol interventions show promising results, however, alcohol remains absent from programming in HIV prevention.


To evaluate the benefits of scaling up an effective alcohol intervention against the opportunity costs of using those resources to scale up alternative interventions. 


Using a published validated computer simulation of the HIV epidemic in Kenya, we evaluated the cost-effectiveness of a CBT-based culturally-adapted alcohol intervention. Given the uncertainty surrounding costs of scale-up, costing assumptions were varied over a wide range, to identify the threshold at which its incremental cost-effectiveness ratio descended below those of alternative resource uses.


A scaled-up CBT alcohol intervention could reduce alcohol-related infections from 13% to 9% of total new infections, thereby adding 137,728 life-years (169,457 QALY) in Kenya over 20-years.

When we assumed an alcohol intervention cost $10/person annually, its cost-effectiveness was $30,000/QALY. Optimistic assumptions regarding the intervention’s effect size lowered the ICER to approximate earlier ART (350 cells/ul vs. 200 cells/ul, $2,600/QALY), and 3x GDP per capita ($2,400/QALY).

When we assumed an alcohol intervention cost $1/person annually its ICER fell to $2,445/QALY, similar to earlier ART initiation and 3x the GDP per capita for Kenya. Optimistic assumptions regarding effect size resulted in the alcohol intervention becoming cost-saving.


Our results highlight the potentially favorable cost-effectiveness for alcohol interventions in Kenya, particularly at costs ≤ $1 per person.

Learning Areas:

Administer health education strategies, interventions and programs
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Assess the optimal share of HIV prevention resources that should be allocated to alcohol interventions. Evaluate and compare alternative portfolios of interventions to reduce HIV infections in Kenya.

Keyword(s): HIV/AIDS, Alcohol Use

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My background is in decision analytic modeling, HIV clinical research and comparative effectiveness, and cost-effectiveness analysis. I am the Director of the Division of Comparative Effectiveness and Decision Science, which was created to facilitate research projects at the interface of clinical research and the decision sciences. I have extensive experience developing, calibrating, validating, and informing public policy with mathematical models in multiple clinical domains, including HIV care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.