The cost-effectiveness of intervening in low and high HIV prevalence areas in South Africa

Abstract

This research compared the cost-effectiveness of a set of HIV/AIDS interventions in a low HIV prevalence area (LPA) and in a high HIV prevalence area (HPA) in South Africa. The rationale for this analysis was to assess the interaction dynamics between a specific HIV/AIDS intervention and an area of implementation and the effects of these dynamics on the cost-effectiveness of such an HIV/AIDS intervention. A pair of Markov models was evaluated for each intervention; one model for a HPA and another for an LPA and the cost-effectiveness of that intervention was compared across an LPA and a HPA. The baseline costs and health outcomes in each area were collected from the literature. To depict interaction dynamics between an HIV/AIDS intervention and an area of implementation, baseline health outcomes collected in each area, were adjusted over time based on the patterns of the projections observed in the AIDS model of the Actuarial Society of South Africa (ASSA2008). The study found that the VCT and treatment of STDs were equally cost-effective in an LPA and in a HPA while PMTCT and HAART were more cost-effective in an LPA than in a HPA. As a policy proposal, resources earmarked to non-ARV based interventions (VCT and treatment of STDs) should  be equally shared across an LPA and a HPA while  more of the resources reserved for ARV-based interventions (PMTCT and HAART) should go in an LPA in order to increase efficiency.