Elsevier

Preventive Medicine

Volume 46, Issue 3, March 2008, Pages 222-225
Preventive Medicine

“Bundling” HIV prevention: Integrating services to promote synergistic gain

https://doi.org/10.1016/j.ypmed.2007.09.006Get rights and content

Abstract

Background.

Bundling is defined as the aggregation of services to increase effectiveness (i.e., creating synergy of effort). The purpose of this commentary is to review the utilization and potential benefits of bundling in its application to HIV prevention.

Methods.

Review of the literature to provide a broad perspective on the concept of bundling and specific examples of bundling in HIV prevention. Benefits, challenges and directions are considered.

Results.

To be effective, bundling must offer strategic advantage: greater value, less cost. It provides an opportunity to target multiple risk behaviors simultaneously for synergistic gain. Technological advances including rapid HIV tests permit noninvasive sampling in clinical and non-clinical settings. Bundling of HIV prevention provides an opportunity to reach high-risk persons who are asymptomatic and/or may not otherwise seek care by eliminating barriers to prevention.

Conclusions.

We must implement programs that work and consider innovative approaches to stem the AIDS epidemic; bundling provides one such opportunity to create an efficient paradigm targeting multiple risk behaviors simultaneously.

Section snippets

Bundling as synergy: offering “strategic advantage”

According to economists, bundling works best when: (1) goods/services are complementary; (2) there is a low marginal cost of added service; (3) consumers value all services; and (4) there is a low correlation in demand for different services (Bakos and Brynjolfsson, 1996). For example, my research team is conducting a randomized controlled trial testing the effect of bundling HIV/STI prevention with prenatal care. These services are complementary and there is a low marginal cost of bundling HIV

Liaison mental health services

Perhaps the earliest (documented in 1751) and best established form of bundling is use of liaison mental health services: integrating mental health services into hospital and clinic settings where patients sought care for physical illness (Callaghan et al., 2003). Within psychiatric treatment, HIV prevention has also been bundled. Carey et al. (2004) randomly assigned patients seeking outpatient psychiatric care to one of three conditions: standard of care, substance use reduction, or bundled

Bundling: benefits, challenges, future directions

There may be numerous benefits to bundling. For institutions, there can be reduced infrastructure needs and costs, the opportunity to sell more services (or simply to give them away) creating a larger market for relatively low valued products (e.g., HIV testing in an environment where it is not the primary service sought), and creation of new collaborative partnerships. For individuals at risk for HIV, bundling can breakdown barriers to care and prevention. It can provide integrated,

Acknowledgments

Support for this article comes from the National Institute of Mental Health R01-MH/HD61175 and R01-MH074399. Thanks to Dr. Edward Kaplan, Yale School of Management, who introduced the bundling nomenclature to me.

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