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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.

Author information

1
Department of Epidemiology, Emory University, Atlanta, GA, USA.
2
Department of Health Policy and Management, Kennesaw State University, Kennesaw, GA, USA.
3
Department of Economics, Emory University, Atlanta, GA, USA.
4
Rollins School of Public Health, Emory University, Atlanta, GA, USA.

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.

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