The cost and cost-effectiveness of gender-responsive interventions for HIV: a systematic review.
BACKGROUND
Harmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective.


METHODS
Effective intervention models were identified from an existing evidence review ("what works for women"). Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects.


RESULTS
Our effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and post-exposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings.


CONCLUSIONS
There has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework.
Social and Mathematical Epidemiology (SaME) Group, London School of Hygiene and Tropical Medicine, London, UK; michelle.remme@lshtm.ac.uk.
Michelle
M
Remme
Social and Mathematical Epidemiology (SaME) Group, London School of Hygiene and Tropical Medicine, London, UK.
Mariana
M
Siapka
Social and Mathematical Epidemiology (SaME) Group, London School of Hygiene and Tropical Medicine, London, UK.
Anna
A
Vassall
Social and Mathematical Epidemiology (SaME) Group, London School of Hygiene and Tropical Medicine, London, UK.
Lori
L
Heise
Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland.
Jantine
J
Jacobi
Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland.
Claudia
C
Ahumada
Health Policy Project, Futures Group, Washington, DC, USA.
Jill
J
Gay
Social and Mathematical Epidemiology (SaME) Group, London School of Hygiene and Tropical Medicine, London, UK.
Charlotte
C
Watts
D003140:Communicable Disease Control / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D012737:Sex Factors
HIV/AIDS; cost; cost-effectiveness; critical enablers; development synergies; gender equality; gender-based violence; investment approaches