238 The Global HIV Epidemics among Sex Workers
Key Themes (continued)
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The cost per DALY saved by the empowerment intervention is high compared to many other HIV prevention interventions, but below others that have been deemed important to support. For example: 1) 50% coverage of School-Based Sex Education at $530; 2) HAART (simple) + Directly Observed Treatment Strategy for TB at $596.
As a percentage of the national health expenditure on HIV programs the empowerment intervention would consume 4.6% in Brazil, 16% in Kenya, and 4.8% in Thailand. In Ukraine it would reduce net HIV expenditure by 9.6% due to averted care costs.
The objectives of this section are to estimate the cost-effectiveness of implementation and expansion of the community empowerment-based comprehensive HIV prevention intervention for sex workers described earlier in the modeling section. We explore the potential impact of the empowerment intervention in Brazil, Kenya, Thailand, and Ukraine under two scenarios: 1) assuming static provision of ART programs at current levels; and 2) in the context of large-scale expansion of ART delivery. These analyses are intended to assist policy makers and program managers in identifying optimal allocation of HIV prevention funds, and provide results in a metric that will allow comparisons of the utility of the intervention to other allocation options, both for HIV prevention and alternative health interventions.
Methods Establishing a Base-Case Cost Estimate For the sex worker community empowerment-based, comprehensive HIV prevention intervention we first did a detailed costing of a model program in Brazil (the Encontros project) that has high fidelity to the proposed intervention of interest using a micro-costing methodology. This intervention was selected as it closely matches the inclusion criteria of those studies included in the meta-analysis used to derive the efficacy estimates, has been well studied, and is located in one of the target countries for this analysis (Brazil). In addition, none of the other selected countries had to date conducted a similar intervention with the necessary evaluation and micro-costing data available. Detailed micro-costing worksheets were completed by staff in Brazil who implemented the Encontros project (Lippman, Donini et al. 2010). A series of queries and revisions were made to refine the estimates, and consultations were made with a study team that earlier evaluated the efficacy of Encontros.