Cost-Effectiveness of Interventions to Prevent HIV Acquisition

Authors: Geoffrey Garnett, Shari Krishnaratne, Kate Harris, Timothy Hallett, Michael Santos, Joanne Enstone, Bernadette Hensen, Gina Dallabetta, Paul Revill, Simon Gregson, James Hargreaves

This chapter reviews current evidence about the efficacy, effectiveness, and costs of HIV/AIDS prevention products, programs, and approaches. Determining the causal impact of prevention activities in reducing HIV infections and ultimately preserving health has proved much more challenging than for many other kinds of health care intervention. One challenge pertains to the design of studies measuring the efficacy and effectiveness of HIV prevention interventions. Prevention cascades could be a powerful tool for analyzing how an HIV prevention product should be delivered and identifying the steps required for its impact. Effectiveness was assessed for direct mechanisms of prevention including condoms, male circumcision, oral preexposure prophylaxis, vaginal or rectal microbicides, and vaccines. Treating other sexually transmitted infections has not reduced susceptibility to HIV. Despite the scale-up of effective treatment, which can contribute to HIV prevention, it is still unclear due to gaps in the evidence which prevention programs are most effective, how best to implement them, and how much should be spent on them.