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An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
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Is your syringe services program cost-saving to society? A methodological case study.

Don C Des Jarlais1, Jonathan Feelemyer2, Courtney McKnight2

  • 1Epidemiology, Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, 7th Floor, New York, NY, 10003, USA. Don.DesJarlais@nyu.edu.

Harm Reduction Journal
|December 8, 2021
PubMed
Summary
This summary is machine-generated.

Syringe services programs (SSPs) are cost-saving when they prevent HIV infections in communities where transmission is controlled. Even programs with a $500,000 budget need to prevent only 3 HIV infections annually to be cost-saving.

Keywords:
Cost-saving analysisHIVPersons who inject drugsSyringe service programs

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Area of Science:

  • Public Health
  • Health Economics
  • Epidemiology

Background:

  • Syringe services programs (SSPs) are recognized for reducing HIV transmission among persons who inject drugs (PWID).
  • Local SSPs often face pressure to demonstrate economic value, but conducting cost-effectiveness studies can be resource-intensive.
  • A simplified method is needed to assess the economic justification of SSPs.

Purpose of the Study:

  • To present a method for estimating the cost-saving threshold for SSPs.
  • To determine the number of HIV infections an SSP must prevent to be considered cost-saving.
  • To provide an economic justification for SSPs that are effective and well-managed.

Main Methods:

  • Utilized existing research on SSP effectiveness and guidelines for high-functioning programs.
  • Developed a three-step method: 1) assess local HIV transmission control in PWID, 2) evaluate SSP operational quality, and 3) divide the SSP's annual budget by the lifetime cost of HIV treatment.
  • Applied this method to estimate the break-even point for cost-savings.

Main Results:

  • An SSP with an annual budget of $500,000 in an area with controlled HIV transmission (incidence ≤1/100 person-years) and functioning very well needs to prevent only 3 new HIV infections per year to be cost-saving.
  • This calculation highlights the significant economic benefit derived from preventing even a small number of HIV infections.

Conclusions:

  • SSPs operating effectively in communities with controlled HIV transmission are highly likely to be cost-saving to society.
  • The high cost of lifelong HIV treatment underscores the economic efficiency of well-run SSPs.
  • This study provides a practical framework for demonstrating the economic value of SSPs.