Comparing the Cost-Effectiveness of HIV Prevention Interventions

This study sought to provide evidence in response to the need of communities to identify cost-effective interventions for HIV prevention as a means to optimise limited resources. The study, done in the United States, included estimates of the relative cost-effectiveness for 26 HIV prevention interventions, which included biomedical interventions, structural interventions, and individual behaviour change interventions. The authors conducted other types of analyses that sought to assess patterns of the cost-effectiveness across different populations using various assumptions. The paper includes background information on estimates of HIV infections prevented, estimates of costs, and comparison of cost-effectiveness and sensitivity analyses.

Results showed that the HIV prevalence of the population at risk and the cost per person reached were the two factors that most strongly determined the cost-effectiveness of the different interventions, across various measurements. In low-prevalence populations (e.g., heterosexuals), the most cost-effective interventions were structural interventions (e.g., mass media, condom distribution), whereas in high-prevalence populations (e.g., men who have sex with men), individually focused interventions to change risk behaviour were also relatively cost-effective. Showing videos in sexually transmitted infection (STI) clinics and raising alcohol taxes were some of the most cost-effective interventions. Authors also report that school-based HIV prevention programmes appeared to be the least cost-effective, a result explained by the low prevalence of HIV in this group. Needle exchange and needle deregulation programmes were relatively cost-effective only when injection drug users have a high HIV prevalence.

The authors state that the study can provide strong evidence for the use of certain interventions in HIV prevention. In addition to the use of mass media, another intervention with great potential, they argue, is the increase of alcohol prices as a way to prevent high risk behavior for HIV. The authors also acknowledge some of the limitations of the study, in particular the model they used, which assumes random selection of partners, and the duration of intervention effectiveness. However, the authors conclude that comparing estimates of the cost-effectiveness of HIV interventions provides insight that can help local communities maximise the impact of their HIV prevention resources.