A Systematic Review on Cost Effectiveness of HIV Prevention Interventions in the United States
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The Centers for Disease Control and Prevention (CDC) focus on funding HIV prevention interventions likely to have high impact on the HIV epidemic. In its most recent funding announcement to state and local health department grantees, CDC required that health departments allocate the majority of funds to four HIV prevention interventions: HIV testing, prevention with HIV-positives and their partners, condom distribution and policy initiatives.
We conducted a systematic review of the published literature to determine the extent of the cost-effectiveness evidence for each of those interventions.
We searched for US-based studies published through October 2012. The studies that qualified for inclusion contained original analyses that reported costs per quality-adjusted life-year saved, life-year saved, HIV infection averted, or new HIV diagnosis. For each study, paired reviewers performed a detailed review and data extraction. We reported the number of studies related to each intervention and summarized key cost-effectiveness findings according to intervention type. Costs were converted to 2011 US dollars.
Of the 50 articles that met the inclusion criteria, 33 related to HIV testing, 15 assessed prevention with HIV-positives and partners, three reported on condom distribution, and one reported on policy initiatives. Methodologies and cost-effectiveness metrics varied across studies and interventions, making them difficult to compare.
Our review provides an updated summary of the published evidence of cost effectiveness of four key HIV prevention interventions recommended by CDC. With the exception of testing-related interventions, including partner services, where economic evaluations suggest that testing often can be cost effective, more cost-effectiveness research is needed to help guide the most efficient use of HIV prevention funds.
KeywordsPolicy Initiative Condom Distribution Partner Service Broad Search Strategy Funding Announcement
We sincerely thank Christy Cechman and Barbara Landreth for their help on our literature search. We also thank Paul Farnham, Ram Shrestha, Feng Lin, Chaitra Gopalappa, Robert Koppenhaver, Stephen Sorenson, Steve Nesheim, and Allan Taylor for their help in reviewing and abstracting studies.
Funding and conflict of interest
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. No sources of funding were used to conduct this study or to prepare this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this review.
Conception and design: YLH, AL, SLS; data collection: YLH, AL; analysis and interpretation: YLH, AL, AH, SLS; writing the article: YLH; critical revision of the article: AL, AH, SLS; overall responsibility: YLH.
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