Cost-Effectiveness of HIV Prevention in Developing Countries

HIV InSite Knowledge Base Chapter
Published September 2002
Elliot Marseille, DrPH, MPP, University of California San Francisco
Stephen F. Morin, PhD, University of California San Francisco
Chris Collins, MPP, Progressive Health Partners
Todd Summers, Progressive Health Partners
Thomas J. Coates, PhD, University of California San Francisco
James G. Kahn, MD, MPH, University of California San Francisco
http://hivinsite.ucsf.edu/InSite?page=kb-08-01-04

Table 1. Cost-Effectiveness of HIV Prevention Interventions in Sub-Saharan Africa

Intervention Population

Intervention

Cost per Disability-Adjusted Life-Year (DALY)

Cost per Case Averted

Study Country

Cost-Effective?

References

Female sex workersSexually transmitted disease control & condom promotion<US$1US$8-US$12Kenya

Yes

a

GeneralSexually transmitted disease controlUS$13US$350Tanzania

Yes

b,c

GeneralVoluntary counseling and testingOverall:
US$12.77 (Kenya)
US$17.78 (Tanzania)HIV+ male as couple:
US$2.75 (Kenya)
US$4.48 (Tanzania)HIV+ female as couple:
US$3.38 (Kenya)
US$2.96 (Tanzania)
Overall:
US$249 (Kenya)
US$346 (Tanzania)HIV+ male as couple:
US$54 (Kenya)
US$87 (Tanzania)HIV+ female as couple:
US$68 (Kenya)
US$58 (Tanzania)
Kenya
Tanzania

Yes

d

Female sex workersFemale condom promotionSavings to health payerSavings to health payerSouth Africa

Yes

e

GeneralSafe blood supplyUS$8US$172Uganda

Yes

f

General
(30% HIV prev., 15% HIV prev.)
Mother-to-child transmissionUS$11-US$19US$298-US$506Uganda

Yes

g

References
  1. Moses S, Plummer FA, Ngugi EN, Nagelkerke NJ, Anzala AO, Ndinya-Achola JO. Controlling HIV in Africa: effectiveness and cost of an intervention in a high-frequency STD transmitter core group. AIDS. 1991 Apr;5(4):407-11.
  2. Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K, Mayaud P, Changalucha J, Nicoll A, ka-Gina G, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. 1995 Aug 26;346(8974):530-6.
  3. Grosskurth H, Mosha F, Todd J, Senkoro K, Newell J, Klokke A, Changalucha J, West B, Mayaud P, Gavyole A, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS. 1995 Aug;9(8):927-34.
  4. Sweat M, Gregorich S, Sangiwa G, Furlonge C, Balmer D, Kamenga C, Grinstead O, Coates T. Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania. [see comments] Lancet. 2000 Jul 8;356(9224):113-21.
  5. Marseille E, Kahn JG, Billinghurst K, Saba J. Cost-effectiveness of the female condom in preventing HIV and STDs in commercial sex workers in rural South Africa. Soc Sci Med. 2001 Jan;52(1):135-48.
  6. European Commission. Safe Blood in Developing Countries: The Lesson from Uganda. R. Winsbury. Luxembourg, Office for Official Publications of the European Commission, 1995.
  7. Marseille E, Kahn JG, Mmiro F, Guay L, Musoke P, Fowler MG, Jackson JB. Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa. Lancet. 1999 Sep 4;354(9181):803-9.