Optimal investment in a portfolio of HIV prevention programs.
OBJECTIVE
In this article, the authors determine the optimal allocation of HIV prevention funds and investigate the impact of different allocation methods on health outcomes.


METHODS
The authors present a resource allocation model that can be used to determine the allocation of HIV prevention funds that maximizes quality-adjusted life years (or life years) gained or HIV infections averted in a population over a specified time horizon. They apply the model to determine the allocation of a limited budget among 3 types of HIV prevention programs in a population of injection drug users and nonusers: needle exchange programs, methadone maintenance treatment, and condom availability programs. For each prevention program, the authors estimate a production function that relates the amount invested to the associated change in risky behavior.


RESULTS
The authors determine the optimal allocation of funds for both objective functions for a high-prevalence population and a low-prevalence population. They also consider the allocation of funds under several common rules of thumb that are used to allocate HIV prevention resources. It is shown that simpler allocation methods (e.g., allocation based on HIV incidence or notions of equity among population groups) may lead to alloctions that do not yield the maximum health benefit.


CONCLUSIONS
The optimal allocation of HIV prevention funds in a population depends on HIV prevalence and incidence, the objective function, the production functions for the prevention programs, and other factors. Consideration of cost, equity, and social and political norms may be important when allocating HIV prevention funds. The model presented in this article can help decision makers determine the health consequences of different allocations of funds.
Zaric
G S
GS
Ivey School of Business, University of Western Ontario, London, Canada.
Brandeau
M L
ML
D018672:Community Health Planning / Q000191:economics* / Q000379:methods*; D017280:Condoms / Q000600:supply & distribution; D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D003662:Decision Theory; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D015276:Health Care Rationing / Q000191:economics / Q000379:methods*; D006801:Humans; D007449:Investments / Q000191:economics*; D008691:Methadone / Q000627:therapeutic use; D017059:Models, Econometric; D018671:Needle-Exchange Programs; D015995:Prevalence; D011314:Preventive Health Services / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000517:prevention & control
D008691:Methadone