Abstract
Investments in community-based HIV prevention programs in Ontario over the past two and a half decades are assumed to have had an impact on the HIV epidemic, but they have never been systematically evaluated. To help close this knowledge gap, we conducted a macro-level evaluation of investment in Ontario HIV prevention programs from the payer perspective. Our results showed that, from 1987 to 2011, province-wide community-based programs helped to avert a total of 16,672 HIV infections, saving Ontario’s health care system approximately $6.5 billion Canadian dollars (range 4.8–7.5B). We also showed that these community-based HIV programs were cost-saving: from 2005 to 2011, every dollar invested in these programs saved about $5. This study is an important first step in understanding the impact of investing in community-based HIV prevention programs in Ontario and recognizing the impact that these programs have had in reducing HIV infections and health care costs.
Highlights
The economic burden of HIV infection is substantial
All estimated savings are reported in 2011 CAD using the corresponding consumer price indices in Ontario [26] b AIDS Bureau of the Ontario Ministry of Health and Long-term Care (MOHLTC) c AIDS Community Action Program (ACAP) managed by the Public Health Agency of Canada Regional Offices d Other governmental funding includes other federal, provincial, regional, and municipal-level funding sources e Other sources includes charitable donations, fundraising, United Way, and others f Reported present value in 2011 dollars using the corresponding consumer price indices [26] and a discount rate of 3 %
From 1987 to 2011, our results show that these programs might have helped to avert approximately 16,672 new cases of HIV infection, and saved a total of $6.5 billion for the Ontario health care system
Summary
The economic burden of HIV infection is substantial. In the United States, on average, the life-time cost per case is estimated as ranging from $253,000 to $402,000 (USD) [1]. Over the past two and a half decades, communitybased programs and behavioural prevention strategies have played key roles in HIV and sexually transmitted infection prevention in Canada, the United States, Australia, the United Kingdom and elsewhere. A significant body of evidence has demonstrated that community-based and behavioural interventions are effective in: reducing risky sexual behaviour and the incidence of sexually transmitted infections in high-risk populations [2,3,4,5,6,7]; increasing condom use [8,9,10]; increasing knowledge of HIV transmission and prevention [7]; improving adherence to antiretroviral therapy [11]; and improving retention to care and treatment [6, 12]. The province has strategically taken into account the impact of stigma, culture and human rights, as well as the social, behavioural and structural factors that affect HIV risk [13, 14]
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