title: The cost-effectiveness of consistent and early intervention of harm reduction for injecting drug users in Bangladesh.
abstract: OBJECTIVE
  To assess the cost-effectiveness of the CARE-SHAKTI harm reduction intervention for injecting drug users (IDUs) over a 3-year period, the impact on the cost-effectiveness of stopping after 3 years and how the cost-effectiveness might vary with baseline human immunodeficiency virus (HIV) prevalence.
  
  
  METHODS
  Economic cost data were collected from the study site and combined with impact estimates derived from a dynamic mathematical model.
  
  
  METHODS
  Dhaka, Bangladesh, where the HIV prevalence has remained low despite high-risk sexual and injecting behaviours, and growing HIV epidemics in neighbouring countries.
  
  
  RESULTS
  The cost per HIV infection prevented over the first 3 years was USD 110.4 (33.1-182.3). The incremental cost-effectiveness of continuing the intervention for a further year, relative to stopping at the end of year 3, is USD 97 if behaviour returns to pre-intervention patterns. When baseline IDU HIV prevalence is increased to 40%, the number of HIV infections averted is halved for the 3-year period and the cost per HIV infection prevented doubles to USD 228.
  
  
  CONCLUSIONS
  The analysis confirms that harm reduction activities are cost-effective. Early intervention is more cost-effective than delaying activities, although this should not preclude later intervention. Starting harm reduction activities when IDU HIV prevalence reaches as high as 40% is still cost-effective. Continuing harm reduction activities once a project has matured is vital to sustaining its impact and cost-effectiveness.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. lorna.guinness@lshtm.ac.uk
authors.forename: Lorna
authors.initials: L
authors.lastname: Guinness
authors.forename: Peter
authors.initials: P
authors.lastname: Vickerman
authors.forename: Zahidul
authors.initials: Z
authors.lastname: Quayyum
authors.forename: Anna
authors.initials: A
authors.lastname: Foss
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watts
authors.forename: Andrea
authors.initials: A
authors.lastname: Rodericks
authors.forename: Tasnim
authors.initials: T
authors.lastname: Azim
authors.forename: Smarajit
authors.initials: S
authors.lastname: Jana
authors.forename: Lilani
authors.initials: L
authors.lastname: Kumaranayake
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000191:economics* / Q000379:methods; D006801:Humans; D008297:Male; D015995:Prevalence; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control