title: Cost effectiveness of targeted HIV prevention interventions for female sex workers in India.
abstract: OBJECTIVE
  To ascertain the cost effectiveness of targeted interventions for female sex workers (FSW) under the National AIDS Control Programme in India.
  
  
  METHODS
  A compartmental mathematical Markov state model was used over a 20-year time horizon (1995-2015) to estimate the cost effectiveness of FSW targeted interventions, with a health system perspective. The incremental costs and effects of FSW targeted interventions were compared against a baseline scenario of mass media for the general population alone. The incremental cost-effectiveness ratio was computed at a 3% discount rate using HIV infections averted and disability-adjusted life-years (DALY) as benefit measures. It was assumed that the transmission of the HIV virus moves from a high-risk group (FSW) to the client population and finally to the general population (partners of clients).
  
  
  RESULTS
  Targeted interventions for FSW result in a reduction of 47% (1.6 million) prevalent and 36% (2.7 million) cumulative HIV cases, respectively, in 2015. Adult HIV prevalence in India, with and without (mass media only) FSW interventions, would be 0.25% and 0.48% in 2015. Indian government and development partners spend an average US $104 (INR4680) per HIV infection averted and US $10.7 (INR483) per DALY averted. Discounting at 3%, FSW targeted interventions cost US $105.5 (INR4748) and US $10.9 (INR490) per HIV case and DALY averted, respectively.
  
  
  CONCLUSIONS
  At the current gross domestic product in India, targeted intervention is a cost-effective strategy for HIV prevention in India.
authors: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. shankarprinja@gmail.com
authors: Shankar
authors: S
authors: Prinja
authors: Pankaj
authors: P
authors: Bahuguna
authors: Shalini
authors: S
authors: Rudra
authors: Indrani
authors: I
authors: Gupta
authors: Manmeet
authors: M
authors: Kaur
authors: S M
authors: SM
authors: Mehendale
authors: Susmita
authors: S
authors: Chatterjee
authors: Samiran
authors: S
authors: Panda
authors: Rajesh
authors: R
authors: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000517:prevention & control*; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D007194:India; D008390:Markov Chains; D008875:Middle Aged; D011314:Preventive Health Services / Q000191:economics* / Q000379:methods; D018570:Risk Assessment; D021841:Safe Sex; D011477:Sex Work; D012747:Sexual Partners; D055815:Young Adult