Sarkar Supriya, Corso Phaedra, Ebrahim-Zadeh Shideh, Kim Patricia, Charania Sana, Wall Kristin
Department of Epidemiology, Emory University, Atlanta, GA, USA.
Department of Health Policy and Management, Kennesaw State University, Kennesaw, GA, USA.
EClinicalMedicine. 2019 May 20;10:10-31. doi: 10.1016/j.eclinm.2019.04.006. eCollection 2019 Apr.
Sub-Saharan Africa carries the highest HIV burden globally. It is important to understand how interventions cost-effectively fit within guidelines and implementation plans, especially in low- and middle-income settings. We reviewed the evidence from economic evaluations of HIV prevention interventions in sub-Saharan Africa to help inform the allocation of limited resources.
We searched PubMed, Web of Science, Econ-Lit, Embase, and African Index Medicus. We included studies published between January 2009 and December 2018 reporting cost-effectiveness estimates of HIV prevention interventions. We extracted health outcomes and cost-effectiveness ratios (CERs) and evaluated study quality using the CHEERS checklist.
60 studies met the full inclusion criteria. Prevention of mother-to-child transmission interventions had the lowest median CERs ($1144/HIV infection averted and $191/DALY averted), while pre-exposure prophylaxis interventions had the highest ($13,267/HIA and $799/DALY averted). Structural interventions (partner notification, cash transfer programs) have similar CERs ($3576/HIA and $392/DALY averted) to male circumcision ($2965/HIA) and were more favourable to treatment-as-prevention interventions ($7903/HIA and $890/DALY averted). Most interventions showed increased cost-effectiveness when prioritizing specific target groups based on age and risk.
The presented cost-effectiveness information can aid policy makers and other stakeholders as they develop guidelines and programming for HIV prevention plans in resource-constrained settings.
撒哈拉以南非洲地区承担着全球最重的艾滋病毒负担。了解干预措施如何符合指南及实施计划的成本效益，尤其是在低收入和中等收入环境中，这很重要。我们回顾了撒哈拉以南非洲地区艾滋病毒预防干预措施经济评估的证据，以帮助为有限资源的分配提供信息。
我们检索了PubMed、科学网、Econ-Lit、Embase和《非洲医学索引》。我们纳入了2009年1月至2018年12月期间发表的报告艾滋病毒预防干预措施成本效益估计的研究。我们提取了健康结果和成本效益比率（CERs），并使用CHEERS清单评估研究质量。
60项研究符合全部纳入标准。预防母婴传播干预措施的CER中位数最低（避免一例艾滋病毒感染为1144美元，避免一个伤残调整生命年为191美元），而暴露前预防干预措施的CER中位数最高（避免一例艾滋病毒感染为13267美元，避免一个伤残调整生命年为799美元）。结构性干预措施（性伴通知、现金转移项目）与男性包皮环切术（避免一例艾滋病毒感染为2965美元）的CER相似（避免一例艾滋病毒感染为3576美元，避免一个伤残调整生命年为392美元），且比治疗即预防干预措施更有利（避免一例艾滋病毒感染为7903美元，避免一个伤残调整生命年为890美元）。大多数干预措施在根据年龄和风险对特定目标群体进行优先排序时显示出成本效益增加。
所提供的成本效益信息可帮助政策制定者和其他利益相关者制定资源有限环境下艾滋病毒预防计划的指南和规划。
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