Objective(s) The aim of the presentation paper is to assess the cost-effectiveness of HIV prevention interventions for female sex workers in India, in the context of large-scale programme effort, the Avahan Programme.

Design/methods We estimate cost-effectiveness using comprehensive measurements of cost; and, impact estimates based on dynamical transmission models of HIV and STI transmission that are fitted to observed prevalence trends. Our primary outcome measure is incremental cost per DALY averted (ICER) for the HIV prevention programme compared to a “do-nothing” base case.

Results In 2007, the implementing NGO cost per person reached at least once in a year ranges from US$47 to US$154. When all costs are taken into account (including expertise enhancement, management and contracting costs), the cost per person reached increases to US$112 to US$ 213, depending on location and year. Median incremental costs per infection averted range from US$ 876 (370, 3040) to US$2574 (1344, 7132). Median incremental costs per DALY averted range from US$49 (20 171) in to US$ 143 (74, 388). These costs per DALY may increase as results from other states are included.

Conclusions This study presents robust evidence that demonstrates that HIV prevention interventions targeted at high risk vulnerable groups can achieve substantial reductions in HIV infections at an acceptable cost in a concentrated epidemic setting. Moreover, we demonstrate cost-effectiveness in the context of a programme that is delivering HIV prevention at scale. However, the achievement of cost-effectiveness varies by setting. Our findings suggest that those responsible for HIV programmes should therefore consider funding targeted HIV prevention programmes at high risk groups in India and beyond, but should take into account setting specific drivers of the HIV epidemic.