The Global Impact of Scaling-Up HIV/AIDS Prevention Programs in Low and Middle-Income Countries

Harvard University, Cambridge, Massachusetts, United States
Science (Impact Factor: 33.61). 04/2006; 311(5766):1474-6. DOI: 10.1126/science.1121176
Source: PubMed


A strong, global commitment to expanded prevention programs targeted at sexual transmission and transmission among injecting
drug users, started now, could avert 28 million new HIV infections between 2005 and 2015. This figure is more than half of
the new infections that might otherwise occur during that period in 125 low- and middle-income countries. Although preventing
these new infections would require investing about U.S.$122 billion over this period, it would reduce future needs for treatment
and care. Our analysis suggests that it will cost about U.S.$3900 to prevent each new infection, but that this will produce
a savings of U.S.$4700 in forgone treatment and care costs. Thus, greater spending on prevention now would not only prevent
more than half the new infections that would occur from 2005 to 2015 but would actually produce a net financial saving as
future costs for treatment and care are averted.

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Available from: Robert Greener
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    • "It has become clichéd to talk of the gaps between policy and action, rhetoric and reality – and yet gaps in coverage and implementation are highlighted time and time again in our primary research. 20 There is as yet no systematic attempt to learn from other sectors – particularly health sectors such as HIV/AIDS or tuberculosis treatment (Bekker, Myer, Orrell, Lawn, & Wood, 2008; Keshavjee & Farmer, 2010; Stover et al., 2006; Stringer et al., 2006) – which have attempted to scale up treatment and prevention fast. There is little knowledge as yet of the links between capacity of individual frontline or mid-level workers, the organisations that employ them, and the system as a whole (Potter & Brough, 2004). "
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    • "Given the magnitude of the problem and the high level of uncertainly regarding comparative effectiveness of interventions, it is imperative that roll-out of large-scale prevention programs incorporate rigorous prospective evaluations of their effectiveness. [10] Its alarming to know that the use of Condom is not practiced in many parts of Europe, and that too in unsafe commercial sexual encounters. The non usage of such a cheap, widely available and easily disposable measure may definitely be posing great threats, towards which timely urgent, sustained and effective attention of the authorities is required. "

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    • "High-income countries were excluded because of several reasons: the bulk of the new infections come from low- and middle-income economies, and thus it is in those countries where the largest impact in terms of HIV infections averted can be made; more developed countries have more resources to spend on health and with relatively less scarcity comes less competition for life-saving interventions; the differences in transmission types and the socio-cultural context warrant a separate analysis by income level [1,16,17]. "
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    ABSTRACT: After more than 25 years, public health programs have not been able to sufficiently reduce the number of new HIV infections. Over 7,000 people become infected with HIV every day. Lack of convincing evidence of cost-effectiveness (CE) may be one of the reasons why implementation of effective programs is not occurring at sufficient scale. This paper identifies, summarizes and critiques the CE literature related to HIV-prevention interventions in low- and middle-income countries during 2005-2008. Systematic identification of publications was conducted through several methods: electronic databases, internet search of international organizations and major funding/implementing agencies, and journal browsing. Inclusion criteria included: HIV prevention intervention, year for publication (2005-2008), setting (low- and middle-income countries), and CE estimation (empirical or modeling) using outcomes in terms of cost per HIV infection averted and/or cost per disability-adjusted life year (DALY) or quality-adjusted life year (QALY). We found 21 distinct studies analyzing the CE of HIV-prevention interventions published in the past four years (2005-2008). Seventeen CE studies analyzed biomedical interventions; only a few dealt with behavioral and environmental/structural interventions. Sixteen studies focused on sub-Saharan Africa, and only a handful on Asia, Latin America and Eastern Europe. Many HIV-prevention interventions are very cost effective in absolute terms (using costs per DALY averted), and also in country-specific relative terms (in cost per DALY measured as percentage of GDP per capita). There are several types of interventions for which CE studies are still not available or insufficient, including surveillance, abstinence, school-based education, universal precautions, prevention for positives and most structural interventions. The sparse CE evidence available is not easily comparable; thus, not very useful for decision making. More than 25 years into the AIDS epidemic and billions of dollars of spending later, there is still much work to be done both on costs and effectiveness to adequately inform HIV prevention planning.
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