Cost-effectiveness of a community-level HIV risk reduction intervention for women living in low-income housing developments.
We conducted a cost-effectiveness analysis of a multi-site community-level HIV prevention trial that enrolled women living in 18 low-income housing developments in 5 U.S. cities. A mathematical model of HIV transmission was used to estimate the number of HIV infections averted and quality-adjusted life years (QALYs) saved by the community-level intervention, based on data obtained from community-wide sexual behavior surveys at baseline and 12-month follow-up. Results indicated that the intervention prevented approximately 1 infection per 3500 women reached by the intervention, at a total cost of 174,845 dollars. The cost per QALY saved by the intervention was 37,433 dollars and the cost per HIV infection averted was 732,072 dollars. The community-level intervention was moderately cost-effective in comparison with other HIV prevention programs for at-risk women. Synergistic approaches to HIV prevention that combine community-level sexual norm change interventions with more intensive risk reduction programs for high-risk women are needed. EDITORS' STRATEGIC IMPLICATIONS: The authors present a promising and efficient community-level HIV prevention approach, with effects beyond the limited scope of individual or small group interventions. This paper represents an example of how an analysis of cost-effectiveness can provide policymakers with information needed for difficult decisions about prevention resource allocations.
Medical College of Wisconsin, USA. johnmas@mcmaster.ca
Ana P
AP
Johnson-Masotti
Steven D
SD
Pinkerton
Kathleen J
KJ
Sikkema
Jeffrey A
JA
Kelly
David A
DA
Wagstaff
D000328:Adult; D018672:Community Health Planning; D003153:Community Health Services / Q000191:economics*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D017059:Models, Econometric; D011203:Poverty; D011322:Primary Prevention / Q000191:economics*; D015397:Program Evaluation; D011446:Prospective Studies; D011638:Public Housing; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D014481:United States; D014504:Urban Health; D014932:Women's Health Services / Q000191:economics*