of a brief behavioral intervention to reduce HIV/STI incidence and promote
condom use among female sex workers in the Mexico-US border region
J.L. Burgos1, J.A. Gaebler1, S.A. Strathdee1, R. Lozada2, H. Staines-Orozco3, T.L. Patterson4,5
1University of California San Diego, Division of Global Public Health, La Jolla, United States, 2Baja California State Public Health Service, HIV/AIDS Prevention Program, Tijuana, Mexico, 3Faculty of Medicine, Autonomous University of Ciudad Juarez, Chihuahua, Mexico, 4University of California San Diego, Department of Psychiatry, La Jolla, United States, 5Veterans Administration San Diego Medical Center, La Jolla, United States
research demonstrated efficacy of a brief behavioral intervention to reduce
HIV and sexually
transmitted infections (STIs) among female sex workers (FSWs) in Tijuana
and Ciudad Juarez,
Mexico, cities on Mexico's border with the US. We assessed the
cost-effectiveness of this intervention.
life-time Markov model was developed to estimate HIV cases prevented, changes
in quality-adjusted life expectancy (QALE), and costs per additional
quality-adjusted life year gained (QALY), comparing no intervention to a
once-only and annual intervention. Future costs and health benefits were
discounted annually at 3%. One-way and multivariate sensitivity analyses
evaluated model robustness.
Results. For a
hypothetical 1,000 FSWs receiving the once-only intervention, there were 33 HIV
cases prevented and 5.7 months of QALE gained compared to no intervention. The
additional cost per QALY gained was US$183(95% CI: $164-$206). For FSWs receiving the intervention annually, there
were 29 additional HIV cases prevented and 4.5 additional months of QALE
compared to the once-only intervention. The additional cost per QALY was US$1,075 (95%CI: US$931-$1,259). When
highly active antiretroviral therapy (HAART) was included in the model, the
annual intervention strategy resulted in net savings of US$1,592 (95% CI: $1,260-$1,929) per
QALY gained and dominated both once-only and no intervention strategies. Even
when considering clinical benefits from HAART, ignoring added costs, the cost
per QALY gained remained below three times the Mexican GDP per capita, and
below established cost-effectiveness thresholds. Results were robust across
extensive sensitivity analyses.
Conclusions. This brief behavioral intervention was shown to be highly cost-effective
among FSWs in two Mexico-US border cities, furthermore our analyses shows the
potential for cost-savings from averted HAART expenditures from this intervention.
Therefore, resources should be allocated to identifying barriers and
facilitators to large scale implementation of this and similar cost-effective
behavioral interventions in similar resource constrained settings.
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