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Scaling up HIV prevention programs is cost effective

Scaling up HIV prevention programs can increase efficiency and thus prevent more HIV infections, according to a study published in the online open access journal BMC Health Services Research. Each doubling of a program’s scale can reduce costs by around a third, and some large programs are ten times more efficient than smaller ones - meaning that many more infections are averted for the same amount of resources.

“Proven prevention methods need to be scaled up rapidly,” says Elliot Marseille, the project director and lead author of the report. “Therefore, the fact that costs tend to go down as scale goes up is good news. This could save millions of lives, as well as keeping in check the number of new patients requiring expensive anti-retroviral therapies.”

Larger prevention programs use money more efficiently than smaller ones, analysis of the “Prevent AIDS: Network for Cost-Effectiveness Analysis” (PANCEA) project suggests. The study, funded by the US National Institutes of Health, seeks to improve HIV prevention funding allocation in low and middle-income countries.

Researchers at the University of California, San Francisco (UCSF) collaborated with local teams to collect recent cost and output data from 206 HIV prevention programs in India, Mexico, Russia, South Africa and Uganda. Six types of interventions were assessed including, voluntary counseling and prevention of mother-to-child transmission. And the team assessed relationship between scale (number of HIV prevention services provided) and unit cost (cost per unit of service).

The ‘scale up – cost down’ effect was seen across many countries and prevention approaches, with some large programs up to 100 times more cost effective than their smaller counterparts. But there is a threshold. When projects expand beyond a certain point, costs can start to rise – an effect noted in 2 types of HIV prevention interventions in India.

As more PANCEA-type data becomes available, researchers will be better able to predict these changes. “The global HIV prevention effort is rapidly increasing, with literally billions of dollars of spending anticipated in coming years.” says James G. Kahn, the project’s principal investigator. “We hope that research of this type will help programs better translate spending into HIV infections averted.”

Charlotte Webber | alfa
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