Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: A Systematic Review

• Type of Material: Article
• Authors: Supriya Sarkar, Emory University; Phaedra Corso, Kennesaw State University; Shideh Ebrahim-Zadeh, Emory University; Patricia Kim, Emory University; Sana Charania, Emory University; Kristin Wall, Emory University
• Language: English
• Date: 2019-04-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2019 Published by Elsevier Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.eclinm.2019.04.006
• Title of Journal or Parent Work: EClinicalMedicine
• ISSN: 2589-5370
• Volume: 10
• Start Page: 10
• End Page: 31
• Grant/Funding Information: National Institutes of Health (K01 MH107320); Laney Graduate School at Emory University; and Emory Center for AIDS Research (P30AI050409).
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Economics, General

Abstract

Background: Sub-Saharan Africa carries the highest HIV burden globally. It is important to understand how interventions cost-effectively fit within guidelines and implementation plans, especially in low- and middle-income settings. We reviewed the evidence from economic evaluations of HIV prevention interventions in sub-Saharan Africa to help inform the allocation of limited resources. Methods: We searched PubMed, Web of Science, Econ-Lit, Embase, and African Index Medicus. We included studies published between January 2009 and December 2018 reporting cost-effectiveness estimates of HIV prevention interventions. We extracted health outcomes and cost-effectiveness ratios (CERs) and evaluated study quality using the CHEERS checklist. Findings: 60 studies met the full inclusion criteria. Prevention of mother-to-child transmission interventions had the lowest median CERs ($1144/HIV infection averted and $191/DALY averted), while pre-exposure prophylaxis interventions had the highest ($13,267/HIA and $799/DALY averted). Structural interventions (partner notification, cash transfer programs) have similar CERs ($3576/HIA and $392/DALY averted) to male circumcision ($2965/HIA) and were more favourable to treatment-as-prevention interventions ($7903/HIA and $890/DALY averted). Most interventions showed increased cost-effectiveness when prioritizing specific target groups based on age and risk. Interpretation: The presented cost-effectiveness information can aid policy makers and other stakeholders as they develop guidelines and programming for HIV prevention plans in resource-constrained settings.