Task-shifting alcohol interventions for HIV+ persons in Kenya: a cost-benefit analysis

Area of Science:

• Public Health
• Health Economics
• Mental Health Interventions

Background:

• Alcohol use is a significant risk factor for HIV transmission and treatment non-adherence among HIV+ patients.
• Implementing effective alcohol interventions is challenging in low-income countries with widespread HIV.
• Assessing intervention cost-effectiveness and long-term economic impact is crucial.

Purpose of the Study:

• To conduct a cost-benefit analysis of task-shifted cognitive-behavioral therapy (CBT) for alcohol use reduction in HIV+ outpatients in Kenya.
• To measure the economic return on investment (ROI) of this intervention from a societal perspective.

Main Methods:

• A cost-benefit analysis was performed on a modeled cohort of 13,440 HIV+ outpatients in Kenya.
• Task-shifted CBT delivered by paraprofessionals was evaluated over a six-year period with a 3% discount rate.
• Economic benefits included reduced HIV incidence and improved productivity; sensitivity analyses were conducted.

Main Results:

• The total cost for CBT rollout was $554,000, with estimated benefits of $628,000, resulting in a benefit-to-cost ratio of 1.13.
• Sensitivity analyses indicated the intervention is cost-saving with a positive ROI under most assumptions.
• The duration of treatment effect significantly influenced the results in sensitivity analyses.

Conclusions:

• Task-shifted CBT is an effective and economical intervention for reducing alcohol use among HIV+ individuals in Kenya.
• The intervention offers both health benefits (reduced morbidity/mortality) and long-term economic savings.
• Findings are relevant for countries facing similar challenges with HIV, alcohol consumption, and mental health workforce shortages.