How inexpensive does an alcohol intervention in Kenya need to be in order to deliver favorable value by reducing HIV-related morbidity and mortality?

Abstract

HIV remains a major cause of preventable morbidity and mortality with 100000 new infections and an estimated 62000 deaths in 2011. At the same time unhealthy alcohol consumption is an important risk factor for HIV acquisition and progression. Kenya has one of the highest rates of unhealthy alcohol use worldwide and as many as 13% of new HIV infections in Kenya may be attributable to unhealthy alcohol use. Randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT)-based interventions addressing unhealthy alcohol consumption in Kenya show promising results increasing abstinence by 45% and decreasing risky sex. However alcohol remains conspicuously absent from programming in HIV and substance abuse. In low-resource settings the benefits of scaling up an effective intervention must be balanced against the opportunity costs of using those resources to scale up alternative interventions with potential benefit (for example increasingly eligibility for first-line antiretroviral therapy). Accordingly the researchers used a published validated computer simulation of the HIV epidemic in Kenya incorporating HIV transmission and disease progression to evaluate the cost-effectiveness of the alcohol intervention reported by Papas et al. Given the uncertainty surrounding costs of scale-up they varied costing assumption over a wide range to identify the threshold at which its incremental cost-effectiveness ratio (ICER) descended below those of alternative resource uses (e.g. when an alcohol intervention brought more “health” than alternative resource uses). [excerpt]