Targeting high-risk groups with HIV prevention services cost-effective for public health
Large-scale HIV prevention programmes targeted at high-risk populations can be enormously cost-effective for public health, according to new research conducted on the Avahan HIV prevention programme in India. The researchers found that in a concentrated epidemic, targeting services at key affected populations, including sex workers and men who have sex with men, will be effective both in averting new infections, and prove to be value for money over time.
Avahan was a large scale HIV prevention programme that took place in southern India from 2004-2008, reaching around 150,000 people at a high risk of HIV. By collaborating with community-based organisations, the programme targeted these key affected populations with sexual health information, condom access, HIV and STI testing, and health service referrals.
Over the course of the programme, 61,000 new HIV infections were averted, including 11,000 among the general population. The cost of this programme reached $US258 million, leaving public health officials lacking confidence in committing this type of money without robust evidence that the programme was value for money. However, the researchers found that for each year lost to morbidity and mortality from HIV, the mean cost for the provider was $46 each year. This number is extremely cost effective in public health, and is comparable to providing childhood immunisation programmes, bed nets to prevent malaria, and promoting good hygiene to prevent diarrhoeal disease. The researchers also evaluated the future cost savings of antiretroviral treatment from the prevention programme, finding it to be economical and well within the willingness to pay threshold.
Since highly active antiretroviral therapy (HAART) was developed, and the benefits of treatment as prevention were established, there has been a lot of focus on scaling-up access to HIV treatment. Whilst this is vital, it is argued that prevention has taken a back seat. This research shows that ‘prevention as prevention’ is just as effective and economical as treatment as prevention. In particular, the programme showed that targeting these marginalised groups was effective in curbing the HIV epidemic both in these populations and in the general population. Whilst the benefits of targeted HIV prevention programmes for key populations are well known, the economic benefit of a large-scale programme had been previously unclear. As such, this research should give decision makers more confidence to develop and implement programmes of this scale.