Outcomes and Cost-Effectiveness of Integrating HIV and Nutrition Service Delivery: Pilots in Malawi and Mozambique

Abstract

This paper provides the first estimates of impact and cost-effectiveness for integrated HIV and nutrition service delivery in sub-Saharan Africa. HIV and undernutrition are synergistic co-epidemics impacting millions of children throughout the region. To alleviate this co-epidemic, UNICEF supported small-scale pilot programs in Malawi and Mozambique that integrated HIV and nutrition service delivery. We use trends from integration sites and comparison sites to estimate the number of lives saved, infections averted and/or undernutrition cases cured due to programmatic activities, and to estimate cost-effectiveness. Results suggest that Malawi’s program had a cost-effectiveness of $11–29/DALY, while Mozambique’s was $16–59/DALY. Some components were more effective than others ($1–4/DALY for Malawi’s Male motivators vs. $179/DALY for Mozambique’s One stop shops). These results suggest that integrating HIV and nutrition programming leads to a positive impact on health outcomes and should motivate additional work to evaluate impact and determine cost-effectiveness using an appropriate research design.

Resumen

Este documento proporciona las primeras estimaciones del impacto y la relación costo-eficacia de la prestación integrada de servicios de VIH y nutrición en África subsahariana. El VIH y la desnutrición son coepidemias sinérgicas que afectan a millones de niños en toda la región. En un esfuerzo por aliviar esta co-epidemia, UNICEF apoyó la ejecución de programas piloto a pequeña escala en Malawi y Mozambique integrando la prestación de servicios de VIH y nutrición. Utilizamos las tendencias en los sitios de integración y sitios de comparación para estimar el número de vidas salvadas, el número de infecciones prevenidas y/o casos de desnutrición curados debido a las actividades programáticas, y estimamos la rentabilidad. Los resultados sugieren que el programa integrado de Malawi tuvo una costo-eficacia de $11–29 por AVAD, mientras que el de Mozambique fue de $16–59 por AVAD. Algunos componentes fueron más efectivos que otros ($1–4 por AVAD para el programa “Hombres Motivadores” de Malawi vs. $179 por AVAD del programa “Ventanillas Únicas” de Mozambique). Los resultados sugieren que la integración de programas de VIH y de nutrición tiene un impacto positivo sobre la salud y motivan más trabajo para evaluar el impacto y determinar costo-eficacia usando un diseño de investigación apropiado.

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Acknowledgments

This work would not have been possible without the support of Drs. Guillermo Marquez, Natercia Tembe, and Graciana Pita. This work was supported by UNICEF under contract #43159886. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of UNICEF. UNICEF Research Group—Maaike Arts, Luisa Brumana, Carolyn O’Donnell, Chewe Luo, Dezi Mahotas, Harvey Mkandawire, Jecinter Oketch, Emmanuel Saka, and Marla Smith.

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Correspondence to Julie N. Bergmann.

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The members of the UNICEF Research Group is listed in Acknowledgments section.

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Bergmann, J.N., Legins, K., Sint, T.T. et al. Outcomes and Cost-Effectiveness of Integrating HIV and Nutrition Service Delivery: Pilots in Malawi and Mozambique. AIDS Behav 21, 703–711 (2017). https://doi.org/10.1007/s10461-016-1400-3

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Keywords

  • HIV
  • Nutrition
  • Integration
  • Service delivery
  • Cost-effectiveness
  • Sub-Saharan Africa