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18. HIV/AIDS Prevention and Treatment

Table 18.4: Cost-Effectiveness of Interventions by Epidemic Profile

Cost-Effectiveness of Interventions by Epidemic Profile
Epidemic profile (2001 US$)UNAIDS estimate of need for 2007
InterventionLow-level epidemic (Middle East and North Africa)Concentrated epidemic (East Asia and the Pacific, Europe and Central Asia, Latin America and the Caribbean, South AsiaGeneralized low- level epidemic (Sub-Saharan Africa)Generalized high- level epidemic (Sub-Saharan Africa)2003 US$ millionsPercentage of all prevention needs
SurveillanceNo CE studies foundNo CE studies foundNo CE studies foundNo CE studies found——
IECNo CE studies foundNo CE studies foundNo CE studies foundNo CE studies found1291
School-based educationNo CE studies foundIndia (E/D/no STIs)SFTRET  US$1,350 per HIV infectionSFTRET  US$68 per DALY (World Bank 1999)No CE studies foundNo CE studies found1001
Abstinence educationNo CE studies foundNo CE studies foundNo CE studies foundNo CE studies found——
VCTNo CE studies foundIndiaSFTRET  US$196 per HIV infectionSFTRET  US$10 per DALY (World Bank 1999)Chad (M/S/no STIs)SFTRET  US$891 to US$5,213 per HIV infectionSFTRET  US$45 to US$261 per DALY (Hutton, Wyss, and N'Diekhor 2003)No CE studies found2,17522
Kenya and Tanzania (M/S/STI) SFTRET  US$270 to US$376 per HIV infectionSFTRET  US$14 to US$19 per DALY (Sweat and others 2000)
Peer-based programsNo CE studies foundUnited States (E/S/no STIs)SFTRET  US$71,113 per HIV infection, US$3,556 per DALY (Pinkerton and others 1998)Chad (sex workers) SFTRET  US$6 to US$30 per HIV infectionSFTRET  US$0 to US$2 per DALY(Hutton, Wyss, and N'Diekhor 2003)No CE studies found3,69637
United States (E/D/no STIs) SFTRET  US$14,934 to US$18,719 per HIV infectionSFTRET  US$747 to US$936 per DALY (Kahn and others 2001)Chad (high-risk men) SFTRET  US$24 to US$1,476 per HIV infectionSFTRET  US$1 to US$74 per DALY(Hutton, Wyss, and N'Diekhor 2003)
India (sex workers) SFTRET  US$52 per HIV infectionSFTRET  US$3 per DALY (World Bank 1999)Chad (youths) SFTRET  US$129 to infinity per HIV infectionSFTRET  US$6 to infinity per DALY (Hutton, Wyss, and N'Diekhor 2003)
India (high-risk men) SFTRET  US$303 per HIV infectionSFTRET  US$15 per DALY (World Bank 1999)Cameroon (E/D/STIs) SFTRET  US$67 to US$137 per HIV infectionSFTRET  US$3 to US$7 per DALY (Kumaranayake and others 1998)
Condom promotion and distribution and IECNo CE studies foundNo CE studies foundNo CE studies foundSouth Africa (female condom) (M/D/STI) SFTRET  US$378 to US$4,094 per HIV infectionSFTRET  US$19 to US$205 per DALY (Marseille and others 2001)1,09311
Condom social marketingNo CE studies foundNo CE studies foundChadSFTRET  US$77 per HIV infection US$4 perSFTRET  DALY (Hutton, Wyss, and N'Diekhor 2003)No CE studies found1982
STI treatmentNo CE studies foundNo CE studies foundChadSFTRET  US$1,675 per HIV infectionSFTRET  US$84 per DALYSFTRET  (Hutton, Wyss, and N'Diekhor 2003)South Africa (E/STI) SFTRET  US$2,093 per HIV infectionSFTRET  US$105 per DALY (Vickerman and others forthcoming)7838
Tanzania (E/S/STI) SFTRET  US$326 per HIV infectionSFTRET  US$16 per DALY (Gilson and others 1997)
Kenya (E/D/STI) SFTRET  US$11 to US$16 per HIV infectionSFTRET  US$1 per DALY (Moses and others 1991)
Antiretroviral therapy to reduce MTCTNo CE studies foundMexicoSFTRET  (M) US$39,230 to US$42,528 per HIV infectionSFTRET  US$2,124 to US$2,303 per DALY (Rely and others 2003)Zambia (E) SFTRET  US$848 per HIV infectionSFTRET  US$34 per DALY (Stringer and others 2003)South Africa (M) SFTRET  US$1,650 to US$3,844 per HIV infectionSFTRET  US$66 to US$154 per DALY (Wilkinson, Floyd, and Gilks 1998)3203
IndiaSFTRET  $2,527 per HIV infectionSFTRET  $126 per DALY (World Bank 1999)Chad (AZT) SFTRET  US$924 to US$4,044 per HIV infectionSFTRET  US$37 to US$162 per DALY (Hutton, Wyss, and N'Diekhor 2003)Sub-Saharan Africa (M) SFTRET  US$5,279 to US$11,444 per HIV infectionSFTRET  US$211 to US$458 per DALY (Marseille, Kahn, and Saba 1998)
Chad (breastfeeding advice) SFTRET  US$1,241 to US$4,382 per HIV infectionSFTRET  US$50 to US$175 per DALY (Hutton, Wyss, and N'Diekhor 2003)Sub-Saharan Africa (nevira- pine) (M) SFTRET  US$142 to US$306 per HIV infectionSFTRET  US$6 to US$12 per DALY (Marseille and others 1999)
MTCT, feeding substitutionNo CE studies foundNo CE studies foundNo CE studies foundNo CE studies found——
Harm reduction for injecting drug usersNo CE studies foundBelarusSFTRET  (E) US$353 per HIV infectionSFTRET  US$18 per DALY (Kumaranayake and others 2004)No CE studies foundNo CE studies found2412
Russia (E) SFTRET  US$564 per HIV infectionSFTRET  US$28 per DALY (Bobrik 2004)
Drug substitution for injecting drug usersNo CE studies foundNo CE studies foundNo CE studies foundNo CE studies found——
Blood safety0.01-1 percent HIV prevalence (M/D/STIs)SFTRETUS$374 to US$45,173 per HIV infectionSFTRETUS$19 to US$2,259 per DALY (Over and Piot 1996)ChadSFTRET  US$75 to US$151 per HIV infectionSFTRET  US$4 to US$8 per DALY (Hutton, Wyss, and N'Diekhor 2003)Zimbabwe (E) SFTRET  US$166 to US$1,010 per HIV infectionSFTRET  US$8 to US$51 per DALY (McFarland and others 1995)230
Zambia (E/D/STI) SFTRET  US$215 to US$262 per HIV infectionSFTRET  US$11 to US$13 per DALY (Watts, Goodman, and Kumaranayake 2000)
Zambia (E) SFTRET  US$41 per HIV infectionSFTRET  US$2 per DALY (Foster and Buve 1995) SFTRET    1-40 percentSFTRET    HIV prevalence US$9 to US$1,806 per HIV infectionSFTRET    US$0.45 to $90 per DALY (Over and Piot 1996)
Sterile injectionMiddle East (M)SFTRET  US$393 per DALY (Dziekan and others 2003)Southeast AsiaSFTRET  US$143 to US$593 per DALYSFTRET  AmericasSFTRET  US$1,851 to US$56,642 per DALYSFTRET  AfricaSFTRET  US$91 to US$230 per DALY (Dziekan and others 2003)941
Western PacificSFTRET  US$953 per DALY (Dziekan and others 2003)
Universal precautionsNo CE studies foundNo CE studies foundNo CE studies foundNo CE studies found6637
Antiretroviral therapy for prevention and postexposure prophylaxisNo CE studies foundUnited States (E/S/no STIs) SFTRET  US$76,584 per HIV infectionSFTRET  US$3,829 per DALY (Pinkerton, Holtgrave, and Bloom 1998)No CE studies foundNo CE studies found131
VaccinesNo CE studies foundNo CE studies foundNo CE studies foundNo CE studies found——
Behavior change for those who are HIV3No CE studies foundNo CE studies foundNo CE studies foundNo CE studies found1121

Source: Authors.

— = not available.

CE = cost-effectiveness.

Note: The authors have categorized each of the studies. The first time each study is mentioned, it is identified by whether it was modeled (M) or empirical (E); whether it calculated primary HIV infections averted (S, for static) or if it also showed secondary infections averted (D, for dynamic); and where appropriate, we indicate if the study also looked at the impact on STIs. The cost-effectiveness of these interventions will differ depending on the population to which they are targeted, (that is, mass interventions versus targeted interventions). In addition, the cost-effectiveness of each intervention may vary greatly by study, because each cost-effectiveness study is not uniform. No cost-effectiveness studies of male condom promotion were found, because condom promotion, distribution, and IEC are generally part of a larger program with many components and studies did not distinguish between the costs of individual components of such programs.

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