Are Targeted HIV Prevention Activities Cost-Effective in High Prevalence Settings? Results From a Sexually Transmitted Infection Treatment Project for Sex Workers in Johannesburg, South Africa

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Objective:The objective of this study was to estimate the cost-effectiveness of syndromic management, with and without periodic presumptive treatment (PPT), in averting sexually transmitted infections (STIs) and HIV in female sex workers (FSWs) participating in a hotel-based intervention in Johannesburg.Study Design:Financial and economic providers' costs were estimated. A mathematical model, fitted to epidemiologic data, projected the HIV and STIs averted by the intervention. Cost per HIV infection and DALY averted were estimated for different general population HIV prevalences.Results:Projections suggest 53 HIV infections were averted (July 2000–June 2001) and a 3.1% decrease in the FSW HIV incidence. Cost-effectiveness was $78 per DALY averted. Incremental cost of PPT was $31 per disability-adjusted life year (DALY) averted. Initiating the intervention at 15% general HIV prevalence would have improved cost-effectiveness by 35%. Expanding PPT coverage to mass-treat all FSWs (instead of <17%) and their clients could increase impact 14-fold.Conclusion:The results highlight targeted interventions can be cost-effective at all stages of HIV epidemics and suggests PPT could improve the cost-effectiveness of targeted STI interventions.

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