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EClinicalMedicine. 2019 May 20;10:10-31. doi: 10.1016/j.eclinm.2019.04.006. eCollection 2019 Apr.

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

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Department of Epidemiology, Emory University, Atlanta, GA, USA.
Department of Health Policy and Management, Kennesaw State University, Kennesaw, GA, USA.
Department of Economics, Emory University, Atlanta, GA, USA.
Rollins School of Public Health, Emory University, Atlanta, GA, USA.



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.


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.


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.


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.

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