Outcomes and Cost-Effectiveness of Integrating HIV and Nutrition Service Delivery: Pilots in Malawi and Mozambique.
This paper provides the first estimates of impact and cost-effectiveness for integrated HIV and nutrition service delivery in sub-Saharan Africa. HIV and undernutrition are synergistic co-epidemics impacting millions of children throughout the region. To alleviate this co-epidemic, UNICEF supported small-scale pilot programs in Malawi and Mozambique that integrated HIV and nutrition service delivery. We use trends from integration sites and comparison sites to estimate the number of lives saved, infections averted and/or undernutrition cases cured due to programmatic activities, and to estimate cost-effectiveness. Results suggest that Malawi's program had a cost-effectiveness of $11-29/DALY, while Mozambique's was $16-59/DALY. Some components were more effective than others ($1-4/DALY for Malawi's Male motivators vs. $179/DALY for Mozambique's One stop shops). These results suggest that integrating HIV and nutrition programming leads to a positive impact on health outcomes and should motivate additional work to evaluate impact and determine cost-effectiveness using an appropriate research design.
Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 507, La Jolla, 92093-507, CA, USA. jnbergmann@ucsd.edu.|Graduate School of Public Health, San Diego State University, San Diego, CA, USA. jnbergmann@ucsd.edu.
Julie N
JN
Bergmann
United Nations Children's Fund, New York, NY, USA.
Kenneth
K
Legins
United Nations Children's Fund, New York, NY, USA.
Tin Tin
TT
Sint
LifeNet International, Global Health Corps, Kampala, Uganda.
Sarah
S
Snidal
Center for Sustainable Development, The Earth Institute, Columbia University, New York, NY, USA.
Yanis Ben
YB
Amor
School of Global Policy and Strategy, University of California, San Diego, La Jolla, CA, USA.
Gordon C
GC
McCord
D002648:Child; D003131:Combined Modality Therapy / Q000191:economics; D015897:Comorbidity; D003362:Cost-Benefit Analysis / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics*; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008295:Malawi; D008297:Male; D009073:Mozambique; D009748:Nutrition Disorders / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D009752:Nutritional Status; D010865:Pilot Projects; D016019:Survival Analysis
Cost-effectiveness; HIV; Integration; Nutrition; Service delivery; Sub-Saharan Africa