Abstract
BackgroundFollowing universal access to antiretroviral therapy in Thailand, evidence from National AIDS Spending Assessment indicates a decreasing proportion of expenditure on prevention interventions. To prompt policymakers to revitalize HIV prevention, this study identifies a comprehensive list of HIV/AIDs preventive interventions that are likely to be effective and cost-effective in Thailand.MethodsA systematic review of the national and international literature on HIV prevention strategies from 1997 to 2008 was undertaken. The outcomes used to consider the effectiveness of HIV prevention interventions were changes in HIV risk behaviour and HIV incidence. Economic evaluations that presented their results in terms of cost per HIV infection averted or cost per quality-adjusted life year (QALY) gained were also included. All studies were assessed against quality criteria.ResultsThe findings demonstrated that school based-sex education plus life-skill programs, voluntary and routine HIV counselling and testing, male condoms, street outreach programs, needle and syringe programs, programs for the prevention of mother-to-child HIV transmission, male circumcision, screening blood products and donated organs for HIV, and increased alcohol tax were all effective in reducing HIV infection among target populations in a cost-effective manner.ConclusionWe found very limited local evidence regarding the effectiveness of HIV interventions amongst specific high risk populations. This underlines the urgent need to prioritise health research resources to assess the effectiveness and cost-effectiveness of HIV interventions aimed at reducing HIV infection among high risk groups in Thailand.
Highlights
Introduction of female condomsNeedle and syringe programNeedle social marketingStreet outreach III
This study found that school based-sex education plus life-skill programs, voluntary and routine HIV counselling and testing, male condoms, street outreach programs, needle and syringe programs, programs for the prevention of mother-to-child HIV transmission, male circumcision, screening blood products and donated organs for HIV, and increased alcohol tax showed strong evidence and value for money in reducing HIV infection among target populations
We found very limited local evidence regarding the effectiveness of HIV interventions among high risk populations in Thailand
Summary
Introduction of female condomsNeedle and syringe programNeedle social marketingStreet outreach III. It is noteworthy that the prioritisation of strategies for dealing with sexually transmitted infections and HIV/ AIDS was a product of their perceived high disease burden, often without reliable evidence regarding the effectiveness and cost-effectiveness of the interventions themselves. Many HIV/AIDS programs have been implemented without close monitoring, or rarely incorporated well-defined control or comparison groups necessary to identify their actual effect size. In parallel to these prevention strategies, a policy for universal antiretroviral treatment has been in operation in Thailand since 2001, with almost 150,000 individuals living with HIV/AIDS currently reaching the program. Evidence from the National AIDS Spending Assessment indicated a decreasing proportion of expenditure on prevention intervention from 18% in 2000 to 13% in 2004 [6]
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