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Cost effectiveness of targeted HIV prevention interventions for female sex workers in India
  1. Shankar Prinja1,
  2. Pankaj Bahuguna1,
  3. Shalini Rudra2,
  4. Indrani Gupta2,
  5. Manmeet Kaur1,
  6. S M Mehendale3,
  7. Susmita Chatterjee4,
  8. Samiran Panda4,
  9. Rajesh Kumar1
  1. 1School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  2. 2Institute of Economic Growth, Delhi University, New Delhi, India
  3. 3National Institute of Epidemiology, Chennai, India
  4. 4National Institute of Cholera and Enteric Diseases (NICED), Kolkata, India
  1. Correspondence to Dr Shankar Prinja, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; shankarprinja{at}


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.

  • Cost effectiveness
  • female sex workers
  • health service research
  • HIV
  • prevention
  • targeted interventions

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  • Funding This study was funded by the National AIDS Control Organization, New Delhi, India.

  • Competing interests All authors have received support from the National AIDS Control Organization, New Delhi, India, for the submitted work.

  • Ethics approval This study was conducted with the approval of the Ethics Committee, PGIMER, Chandigarh, India.

  • Provenance and peer review Not commissioned; externally peer reviewed.