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An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
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HIV prevention cost-effectiveness: a systematic review.

Omar Galárraga1, M Arantxa Colchero, Richard G Wamai

  • 1Center for Evaluation Research and Surveys, Mexican School of Public Health/National Institute of Public Health (INSP), Av. Universidad 655, Cuernavaca, Mexico CP 62508. ogalarraga@insp.mx.

BMC Public Health
|November 20, 2009
PubMed
Summary

Cost-effectiveness (CE) studies for HIV prevention are lacking, hindering program scale-up. Many interventions are cost-effective, but more research is needed for better decision-making.

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Area of Science:

  • Public Health
  • Health Economics
  • Epidemiology

Background:

  • Despite decades of effort, new HIV infections remain high globally.
  • Limited evidence on cost-effectiveness (CE) impedes the scaled implementation of effective HIV prevention programs.
  • This review focuses on the CE literature of HIV prevention interventions in low- and middle-income countries (LMICs) from 2005-2008.

Purpose of the Study:

  • To identify, summarize, and critique the existing cost-effectiveness (CE) literature for HIV prevention interventions.
  • To assess the evidence base for scaling up HIV prevention programs in resource-limited settings.
  • To highlight gaps in CE research for informing future HIV prevention planning.

Main Methods:

  • Systematic literature search across electronic databases, organizational websites, and journal browsing.
  • Inclusion criteria: HIV prevention interventions, 2005-2008 publication years, LMICs, and CE estimation (cost per HIV infection averted or DALY/QALY).
  • Analysis of empirical and modeling studies on the economic impact of HIV prevention.

Main Results:

  • Twenty-one distinct CE studies on HIV prevention were identified (2005-2008).
  • Seventeen studies focused on biomedical interventions; behavioral and structural interventions were less represented.
  • Many interventions demonstrated strong cost-effectiveness, both in absolute terms (cost per DALY averted) and relative to national income (GDP per capita).

Conclusions:

  • Significant gaps exist in CE evidence for crucial interventions like surveillance, abstinence, school-based education, and structural prevention.
  • The available CE evidence is often not comparable, limiting its utility for policy and decision-making.
  • Substantial work is still required on both cost and effectiveness data to adequately guide global HIV prevention strategies.