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The Cost-Effectiveness of HIV Prevention Interventions for HIV-Infected Patients Seen in Clinical Settings

Marseille, Elliot DrPH, MPP; Shade, Starley B PhD; Myers, Janet PhD, MPH; Morin, Steve PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1st, 2011 - Volume 56 - Issue 3 - p e87-e94
doi: 10.1097/QAI.0b013e318204123e
Implementation and Operational Research: Epidemiology and Prevention

Background: The US Health Resources and Services Administration sponsored a 5-year initiative to test three types of counseling-based interventions to reduce HIV transmission among HIV-infected patients delivered in clinical settings. We assessed the cost and cost-effectiveness of the three types of interventions at 13 sites: primary care provider-based (clinical provider); social worker or peer educator-based (specialist); and a mix of primary care and specialist-based (mixed).

Methods: We developed a cost-effectiveness model to calculate average and incremental cost-effectiveness ratios and the cost-effectiveness of the 13 sites combined.

Results: Spending over all 3 years of the demonstration averaged $1004, $3173, and $3430 per client served for clinical provider, specialist, and mixed services, respectively. Unit costs declined with the volume of services provided for all three intervention types. The cost-effectiveness of the clinical provider sites was $107,656 per HIV case averted compared with no intervention. Clinical provider sites were less costly and more effective than the specialist or mixed sites.

Conclusions: Compared with the lifetime cost of HIV/AIDS care and with other effective HIV prevention interventions, the clinical provider-led interventions in this study are cost-effective. In an incremental comparison with clinical provider sites, specialist and mixed intervention sites were not cost-effective.

From the *Health Strategies International, Oakland, CA; and †Center for AIDS Prevention Studies, University of California-San Francisco, San Francisco, CA.

Received for publication June 18, 2010; accepted October 28, 2010.

This publication is supported by grant number 5 H97 HA00261 from the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of HRSA or the SPNS Program.

The authors have no conflicts of interest to disclose.

Correspondence to: Elliot Marseille, DrPH, MPP, Health Strategies International, 555 59th Street, Oakland, CA 94609 (e-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.