Cost effectiveness of targeted HIV prevention interventions for female sex workers in India
- Shankar Prinja1,
- Pankaj Bahuguna1,
- Shalini Rudra2,
- Indrani Gupta2,
- Manmeet Kaur1,
- S M Mehendale3,
- Susmita Chatterjee4,
- Samiran Panda4,
- Rajesh Kumar1
- 1School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- 2Institute of Economic Growth, Delhi University, New Delhi, India
- 3National Institute of Epidemiology, Chennai, India
- 4National Institute of Cholera and Enteric Diseases (NICED), Kolkata, India
- Correspondence to Dr Shankar Prinja, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; shankarprinja{at}gmail.com
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Contributors S. Prinja: Developed the model, interpreted the results and wrote the manuscript. PB: Contributed to development of the model, reviewed literature and performed sensitivity analysis. RK, SMM, MK, S.Panda and IG: Contributed to conceptualisation of the model, results interpretation, reviewed and revised the manuscript. SR and SC: Reviewed literature for estimating parameters and reviewed the manuscript. All authors approved the final version of manuscript being submitted to the journal for publication.
- Accepted 13 February 2011
- Published Online First 29 March 2011
Abstract
Objective To ascertain the cost effectiveness of targeted interventions for female sex workers (FSW) under the National AIDS Control Programme in India.
Methods A compartmental mathematical Markov state model was used over a 20-year time horizon (1995–2015) to estimate the cost effectiveness of FSW targeted interventions, with a health system perspective. The incremental costs and effects of FSW targeted interventions were compared against a baseline scenario of mass media for the general population alone. The incremental cost-effectiveness ratio was computed at a 3% discount rate using HIV infections averted and disability-adjusted life-years (DALY) as benefit measures. It was assumed that the transmission of the HIV virus moves from a high-risk group (FSW) to the client population and finally to the general population (partners of clients).
Result Targeted interventions for FSW result in a reduction of 47% (1.6 million) prevalent and 36% (2.7 million) cumulative HIV cases, respectively, in 2015. Adult HIV prevalence in India, with and without (mass media only) FSW interventions, would be 0.25% and 0.48% in 2015. Indian government and development partners spend an average US$104 (INR4680) per HIV infection averted and US$10.7 (INR483) per DALY averted. Discounting at 3%, FSW targeted interventions cost US$105.5 (INR4748) and US$10.9 (INR490) per HIV case and DALY averted, respectively.
Conclusion At the current gross domestic product in India, targeted intervention is a cost-effective strategy for HIV prevention in India.
Footnotes
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Funding This study was funded by the National AIDS Control Organization, New Delhi, India.
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Competing interests All authors have received support from the National AIDS Control Organization, New Delhi, India, for the submitted work.
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Ethics approval This study was conducted with the approval of the Ethics Committee, PGIMER, Chandigarh, India.
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Provenance and peer review Not commissioned; externally peer reviewed.
