Efficiency of Interventions in HIV Infection, 1994-2004

The pandemic caused by HIV is one of the fastest growing health problems in the world today. Given the limited resources available to healthcare systems in many of the most heavily affected countries, it is crucially important to know the effectiveness, efficiency, equity, and acceptability of the interventions being implemented to contain this pandemic. This review examines the peer-reviewed literature on the efficiency of prevention, treatment and care interventions published between 1994 and 2004, findings reported by these studies, and methods used. The results varied by geographical setting and population studied. Some interventions were clearly cost effective including: prevention efforts and testing programs among vulnerable populations; blood screening in high-income nations and in sub-Saharan Africa; providing antiretroviral drugs and other interventions to expectant mothers and infants; treating certain opportunistic infections; and providing combination anti-retroviral therapy. However, most studies were set in the US, while only one in six dealt with sub-Saharan Africa. Few studies could be identified from continental Asia and none from Latin America. Three-quarters of all papers focused on hospital or primary care settings, with only prevention studies regularly evaluating community-based interventions. There is a paucity of primary data and thus, outcomes or costs were frequently modeled, using data from multiple sources in the absence of context-specific data. Establishing multicenter prospective monitoring systems on the use, cost and outcome of HIV service provision in middle and lower income countries may provide data to fill some of the large gaps which exist in the literature on interventions in these countries. The resulting gaps in the current scientific literature limits the ability for it to guide policy makers in those settings where the epidemic is most intense. Increased research in such settings and dissemination of their findings is urgently required, especially given the need for intensified prevention strategies to complement the scaling up of HIV treatment and care services in these countries.