Abstract
This research compared the cost-effectiveness of a set of HIV/AIDS interventions in a low HIV prevalence area (LPA) and in a high HIV prevalence area (HPA) in South Africa. The rationale for this analysis was to assess the interaction dynamics between a specific HIV/AIDS intervention and an area of implementation and the effects of these dynamics on the cost-effectiveness of such an HIV/AIDS intervention. A pair of Markov models was evaluated for each intervention; one model for a HPA and another for an LPA and the cost-effectiveness of that intervention was compared across an LPA and a HPA. The baseline costs and health outcomes in each area were collected from the literature. To depict interaction dynamics between an HIV/AIDS intervention and an area of implementation, baseline health outcomes collected in each area, were adjusted over time based on the patterns of the projections observed in the AIDS model of the Actuarial Society of South Africa (ASSA2008). The study found that the VCT and treatment of STDs were equally cost-effective in an LPA and in a HPA while PMTCT and HAART were more cost-effective in an LPA than in a HPA. As a policy proposal, resources earmarked to non-ARV based interventions (VCT and treatment of STDs) should be equally shared across an LPA and a HPA while more of the resources reserved for ARV-based interventions (PMTCT and HAART) should go in an LPA in order to increase efficiency.
Highlights
Tailoring the HIV response to the contexts of the epidemic has been claimed to be one of the best responses to HIV/AIDS (Grassly, Garnett, Schwartlander, Gregson, & Anderson, 2001; Parker & Aggleton, 2002; Walker, 2003)
In 2010, in South Africa, more than 5 million people were living with HIV/AIDS and about 188,000 people died of AIDS in that year whilst about 116,000 new infections occurred (Actuarial Society of South Africa, ASSA2008 model)
In the context of limited resources to meet HIV/AIDS services demand, the question revolves around whether HIV/AIDS interventions could be more optimal in some areas of specific prevalence levels than in others, a question to be answered by hard evidence on costs and health outcomes in these areas
Summary
Tailoring the HIV response to the contexts of the epidemic has been claimed to be one of the best responses to HIV/AIDS (Grassly, Garnett, Schwartlander, Gregson, & Anderson, 2001; Parker & Aggleton, 2002; Walker, 2003). In the case of an LPA and a HPA, these complex relationships imply that the cost-effectiveness of interventions across the two areas is not obvious In this regard, the paper simulates the costs, health outcomes and cost-effectiveness of a set of HIV/AIDS interventions in these areas in South Africa. Risk factors have been found to influence health theoretically and empirically through their influence on health-seeking behaviour and on attitudes towards health interventions (Bandura, 1986, Becker, 1974, Geoffard & Phillipson, 1996), and their linkage with culture (Airhihenbuwa, 2004) They are expected to be at centre stage of the differences in new infections, sickness and deaths, even in the presence of HIV/AIDS interventions. In the context of limited resources to meet HIV/AIDS services demand, the question revolves around whether HIV/AIDS interventions could be more optimal in some areas of specific prevalence levels than in others, a question to be answered by hard evidence on costs and health outcomes in these areas
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