Limits...
Estimating the Cost-Effectiveness of HIV Prevention Programmes in Vietnam, 2006-2010: A Modelling Study.

Pham QD, Wilson DP, Kerr CC, Shattock AJ, Do HM, Duong AT, Nguyen LT, Zhang L - PLoS ONE (2015)

Bottom Line: This study investigates the potential epidemiological impacts of these programmes and their cost-effectiveness.Our evaluation suggests that HIV programmes in Vietnam have most likely had benefits that are cost-effective.ART and direct HIV prevention were the most cost-effective interventions in reducing HIV disease burden.

View Article: PubMed Central - PubMed

Affiliation: Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia; Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam.

ABSTRACT

Introduction: Vietnam has been largely reliant on international support in its HIV response. Over 2006-2010, a total of US$480 million was invested in its HIV programmes, more than 70% of which came from international sources. This study investigates the potential epidemiological impacts of these programmes and their cost-effectiveness.

Methods: We conducted a data synthesis of HIV programming, spending, epidemiological, and clinical outcomes. Counterfactual scenarios were defined based on assumed programme coverage and behaviours had the programmes not been implemented. An epidemiological model, calibrated to reflect the actual epidemiological trends, was used to estimate plausible ranges of programme impacts. The model was then used to estimate the costs per averted infection, death, and disability adjusted life-year (DALY).

Results: Based on observed prevalence reductions amongst most population groups, and plausible counterfactuals, modelling suggested that antiretroviral therapy (ART) and prevention programmes over 2006-2010 have averted an estimated 50,600 [95% uncertainty bound: 36,300-68,900] new infections and 42,600 [36,100-54,100] deaths, resulting in 401,600 [312,200-496,300] fewer DALYs across all population groups. HIV programmes in Vietnam have cost an estimated US$1,972 [1,447-2,747], US$2,344 [1,843-2,765], and US$248 [201-319] for each averted infection, death, and DALY, respectively.

Conclusions: Our evaluation suggests that HIV programmes in Vietnam have most likely had benefits that are cost-effective. ART and direct HIV prevention were the most cost-effective interventions in reducing HIV disease burden.

No MeSH data available.


Related in: MedlinePlus

Observed HIV prevalence trends amongst key affected populations and low-risk females under the status quo versus projected prevalence trends in the absence of targeted programmes.Risk behaviours or interventions (left panels) and HIV prevalences (right panels) for each population group. HIV prevalence amongst pregnant women (as the low-risk female population) was assumed to be representative for the prevalence amongst the general population. Curves presented in the five figures in the left column were obtained from a generalised 4-parameter logistic function, whereas curves in the five right-hand figures were model trajectories. Solid curves represent median of 40 best-fitting trends under the status quo. Dashed curves represent assumed behaviour or modelled prevalence trends in the absence of programmes (i.e. the counterfactual). Black dots with solid vertical lines represent observed survey data with 95% confidence intervals. The vertical dash line indicates the initial year of programme implementation.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4510535&req=5

pone.0133171.g002: Observed HIV prevalence trends amongst key affected populations and low-risk females under the status quo versus projected prevalence trends in the absence of targeted programmes.Risk behaviours or interventions (left panels) and HIV prevalences (right panels) for each population group. HIV prevalence amongst pregnant women (as the low-risk female population) was assumed to be representative for the prevalence amongst the general population. Curves presented in the five figures in the left column were obtained from a generalised 4-parameter logistic function, whereas curves in the five right-hand figures were model trajectories. Solid curves represent median of 40 best-fitting trends under the status quo. Dashed curves represent assumed behaviour or modelled prevalence trends in the absence of programmes (i.e. the counterfactual). Black dots with solid vertical lines represent observed survey data with 95% confidence intervals. The vertical dash line indicates the initial year of programme implementation.

Mentions: Behaviour trends indicated lower risk behaviours over time amongst PWID and different groups of FSWs (Fig 2a, 2c and 2e). Condom use by MSM was increasing, but remained at low levels over the study period (Fig 2g). Despite these changes, our model trajectories of HIV prevalence were within confidence intervals of observed data. However, prevalence trends decreased amongst PWID and FSWs associated with the reduction in risk behaviour. According to our assumed counterfactual scenarios of coverage and risk levels without the interventions, the prevention programmes reduced prevalence and brought a decline in prevalence amongst KAPs, particularly PWID and FSWs (Fig 2b, 2d and 2f), but not MSM (Fig 2h). A low but gradually increasing percentage of condom use amongst MSM under the status quo, given the relatively limited investment in HIV programmes targeting MSM, would contribute to the slowing down of HIV transmission in MSM but was impossible to reserve its rising trend. Of note, implementation of the ART programme had led to a slightly higher HIV prevalence in general population, as compared to the counterfactual scenario in which ART was absent (0.30% versus 0.29% in 2010, respectively, Fig 2j), due to its large population benefits in reducing the numbers of HIV-related deaths and incident infections (41,616 [95% uncertainty bound: 35,406–53,515] and 14,249 [10,426–21,23], respectively, Table 1).


Estimating the Cost-Effectiveness of HIV Prevention Programmes in Vietnam, 2006-2010: A Modelling Study.

Pham QD, Wilson DP, Kerr CC, Shattock AJ, Do HM, Duong AT, Nguyen LT, Zhang L - PLoS ONE (2015)

Observed HIV prevalence trends amongst key affected populations and low-risk females under the status quo versus projected prevalence trends in the absence of targeted programmes.Risk behaviours or interventions (left panels) and HIV prevalences (right panels) for each population group. HIV prevalence amongst pregnant women (as the low-risk female population) was assumed to be representative for the prevalence amongst the general population. Curves presented in the five figures in the left column were obtained from a generalised 4-parameter logistic function, whereas curves in the five right-hand figures were model trajectories. Solid curves represent median of 40 best-fitting trends under the status quo. Dashed curves represent assumed behaviour or modelled prevalence trends in the absence of programmes (i.e. the counterfactual). Black dots with solid vertical lines represent observed survey data with 95% confidence intervals. The vertical dash line indicates the initial year of programme implementation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4510535&req=5

pone.0133171.g002: Observed HIV prevalence trends amongst key affected populations and low-risk females under the status quo versus projected prevalence trends in the absence of targeted programmes.Risk behaviours or interventions (left panels) and HIV prevalences (right panels) for each population group. HIV prevalence amongst pregnant women (as the low-risk female population) was assumed to be representative for the prevalence amongst the general population. Curves presented in the five figures in the left column were obtained from a generalised 4-parameter logistic function, whereas curves in the five right-hand figures were model trajectories. Solid curves represent median of 40 best-fitting trends under the status quo. Dashed curves represent assumed behaviour or modelled prevalence trends in the absence of programmes (i.e. the counterfactual). Black dots with solid vertical lines represent observed survey data with 95% confidence intervals. The vertical dash line indicates the initial year of programme implementation.
Mentions: Behaviour trends indicated lower risk behaviours over time amongst PWID and different groups of FSWs (Fig 2a, 2c and 2e). Condom use by MSM was increasing, but remained at low levels over the study period (Fig 2g). Despite these changes, our model trajectories of HIV prevalence were within confidence intervals of observed data. However, prevalence trends decreased amongst PWID and FSWs associated with the reduction in risk behaviour. According to our assumed counterfactual scenarios of coverage and risk levels without the interventions, the prevention programmes reduced prevalence and brought a decline in prevalence amongst KAPs, particularly PWID and FSWs (Fig 2b, 2d and 2f), but not MSM (Fig 2h). A low but gradually increasing percentage of condom use amongst MSM under the status quo, given the relatively limited investment in HIV programmes targeting MSM, would contribute to the slowing down of HIV transmission in MSM but was impossible to reserve its rising trend. Of note, implementation of the ART programme had led to a slightly higher HIV prevalence in general population, as compared to the counterfactual scenario in which ART was absent (0.30% versus 0.29% in 2010, respectively, Fig 2j), due to its large population benefits in reducing the numbers of HIV-related deaths and incident infections (41,616 [95% uncertainty bound: 35,406–53,515] and 14,249 [10,426–21,23], respectively, Table 1).

Bottom Line: This study investigates the potential epidemiological impacts of these programmes and their cost-effectiveness.Our evaluation suggests that HIV programmes in Vietnam have most likely had benefits that are cost-effective.ART and direct HIV prevention were the most cost-effective interventions in reducing HIV disease burden.

View Article: PubMed Central - PubMed

Affiliation: Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia; Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam.

ABSTRACT

Introduction: Vietnam has been largely reliant on international support in its HIV response. Over 2006-2010, a total of US$480 million was invested in its HIV programmes, more than 70% of which came from international sources. This study investigates the potential epidemiological impacts of these programmes and their cost-effectiveness.

Methods: We conducted a data synthesis of HIV programming, spending, epidemiological, and clinical outcomes. Counterfactual scenarios were defined based on assumed programme coverage and behaviours had the programmes not been implemented. An epidemiological model, calibrated to reflect the actual epidemiological trends, was used to estimate plausible ranges of programme impacts. The model was then used to estimate the costs per averted infection, death, and disability adjusted life-year (DALY).

Results: Based on observed prevalence reductions amongst most population groups, and plausible counterfactuals, modelling suggested that antiretroviral therapy (ART) and prevention programmes over 2006-2010 have averted an estimated 50,600 [95% uncertainty bound: 36,300-68,900] new infections and 42,600 [36,100-54,100] deaths, resulting in 401,600 [312,200-496,300] fewer DALYs across all population groups. HIV programmes in Vietnam have cost an estimated US$1,972 [1,447-2,747], US$2,344 [1,843-2,765], and US$248 [201-319] for each averted infection, death, and DALY, respectively.

Conclusions: Our evaluation suggests that HIV programmes in Vietnam have most likely had benefits that are cost-effective. ART and direct HIV prevention were the most cost-effective interventions in reducing HIV disease burden.

No MeSH data available.


Related in: MedlinePlus