Larger HIV prevention programs are cheaper

A UCSF-led team of researchers has found that larger HIV prevention programs in low and middle-income countries can increase efficiency and cause program unit costs to plummet. HIV prevention programs in Uganda, South Africa, Mexico, Russia and India were examined.

“With the recent report from the Global HIV Prevention Working Group urging that funding for proven prevention programming double over the next three years, leading to billions of dollars in spending, we show that this additional funding could not only increase capacity but potentially also increase efficiency by lowering unit costs of prevention services. This means that more HIV infections may be averted,” said the study’s principal investigator, James G. Kahn, MD, MPH, professor at UCSF’s Institute for Health Policy Studies and AIDS Research Institute.

In the study, published in the online open access journal BMC Health Services Research, researchers examined six types of ongoing prevention interventions: voluntary counseling and testing, programs targeting sex workers, treatment for curable sexually transmitted diseases, information, education and communication initiatives, risk reduction programs for injection drug users and programs preventing transmission of HIV from mother to child.

“We found that, on average, each doubling of scale of a prevention program reduced unit costs by a third. Although our analysis is broad—some programs are inefficient because they are small while some programs are small because they are not well managed—rapidly ramping up well-run existing programs could have an immediate, startling effect in improving efficiency, reducing costs and containing the epidemic,” said the study’s lead author, Elliot Marseille, DrPH, MPP, a researcher at UCSF’s Institute for Health Policy Studies.

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The research was conducted by a team from PANCEA and co-authors include Lalit Dandona and S.G. Prem Kumar, the George Institute for International Health, Hyderabad, India; Neil Marshall, Office of AIDS Research, NIH; Sergio Bautista-Arredondo and Stefano M. Bertozzi, Instituto Nacional de Salud Publico, Mexico; Jerry Coovadia, Jo-Ann Du Plessis and Nicci Stanley, Centre For HIV/AIDS Networking, Durban, South Africa; Joseph Saba and Sowedi Muyingo, Axios International; Dmitry Lioznov and Evgeny Kruptisky, St. Petersburg Pavlov State Medical University; Mead Over, Center for Global Development; Alena Pershkins, AIDS Infoshare; Christian Pitter, Elizabeth Glazer Pediatric AIDS Foundation; and Mattias Lundberg, World Bank.

PANCEA, http://hivinsite.ucsf.edu/InSite?page=pancea, is an NIH-funded research project designed to provide information to help increase the efficiency of HIV prevention programs. PANCEA has studied prevention in five countries. PANCEA analyzed output, cost, and quality data from 200 prevention program sites.

The AIDS Research Institute, http://ari.ucsf.edu/, coordinates all of the HIV/AIDS research, treatment, and prevention activities at UCSF. Combining the best basic science, bench-to-bedside research, behavioral studies, direct care services, and policy development, the ARI at UCSF is one of the premier HIV/AIDS medical, education, and research institutions in the world.