July 12, 2005
For the first time a national strategy for prevention of HIV infection has been developed based on the cost-effectiveness of different HIV prevention programs. The strategy and the mathematical model on which it is based are published in the July/August edition of the policy journal Health Affairs.
"As a society, we have an interest in knowing that each dollar we spend towards preventing HIV is going as far as it possibly can," says co-author Tom Farley, chair of community health sciences at the Tulane University School of Public Health and Tropical Medicine. "Following a model like ours could prevent more people from getting infected with HIV for the same amount of money as we are currently spending. Public health leaders in the U.S. should expand the range of approaches used to prevent HIV infection and combine them more strategically."
According to Farley, the model demonstrates the benefit of strategically selecting cost-effective HIV prevention programs to separately target high- and low-risk populations. Despite multiple programs for preventing the spread of HIV, the rate of infection has not declined in past years.
Farley and co-authors Debra Cohen and Shin-Yi Wu identified nine HIV interventions that when used together strategically might prevent close to 21,000 HIV infections a year. Cohen and Wu are researchers with RAND Health. The team gathered information from other published studies on the effectiveness and cost of many different HIV prevention methods used in the United States, including individual counseling, treatment of drug addiction, and antiviral treatment of HIV-infected persons to reduce their infectivity to others.
They then estimated the potential number of HIV infections that could by prevented by allocating funds to a combination of the most cost-effective prevention methods for high- and low-risk populations. The study's most notable recommendations for HIV prevention interventions include: Using community members and organizations to target men who have sex with men could prevent nearly 9,000 HIV infections per year.
Needle exchange programs, which are most cost-effective when used for IV drug users in areas with a high HIV prevalence, could prevent close to 2,300 new cases of HIV. Mass-media campaigns containing messages to reduce risky sexual behavior and programs to distribute free condoms could prevent an estimated 1,100 and 1,900 new infections in lower risk populations.
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