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American Journal of Public Health logoLink to American Journal of Public Health
. 1998 Aug;88(8):1239–1242. doi: 10.2105/ajph.88.8.1239

Cost-effectiveness of a community-level HIV risk reduction intervention.

S D Pinkerton 1, D R Holtgrave 1, W J DiFranceisco 1, L Y Stevenson 1, J A Kelly 1
PMCID: PMC1508314  PMID: 9702159

Abstract

OBJECTIVES: The authors evaluated the cost-effectiveness of a community-level HIV prevention intervention that used peer leaders to endorse risk reduction among gay men. METHODS: A mathematical model of HIV transmission was used to translate reported changes in sexual behavior into an estimate of the number of HIV infections averted. RESULTS: The intervention cost $17,150, or about $65,000 per infection averted, and was therefore cost-saving, even under very conservative modeling assumptions. CONCLUSIONS: For this intervention, the cost of HIV prevention was more than offset by savings in averted future medical care costs. Community-level interventions to prevent HIV transmission that use existing social networks can be highly cost-effective.

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Selected References

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  1. Choi K. H., Coates T. J. Prevention of HIV infection. AIDS. 1994 Oct;8(10):1371–1389. doi: 10.1097/00002030-199410000-00003. [DOI] [PubMed] [Google Scholar]
  2. DeGruttola V., Seage G. R., 3rd, Mayer K. H., Horsburgh C. R., Jr Infectiousness of HIV between male homosexual partners. J Clin Epidemiol. 1989;42(9):849–856. doi: 10.1016/0895-4356(89)90098-x. [DOI] [PubMed] [Google Scholar]
  3. DiClemente R. J., Wingood G. M. A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. JAMA. 1995 Oct 25;274(16):1271–1276. [PubMed] [Google Scholar]
  4. Grant R. M., Wiley J. A., Winkelstein W. Infectivity of the human immunodeficiency virus: estimates from a prospective study of homosexual men. J Infect Dis. 1987 Jul;156(1):189–193. doi: 10.1093/infdis/156.1.189. [DOI] [PubMed] [Google Scholar]
  5. Guinan M. E., Farnham P. G., Holtgrave D. R. Estimating the value of preventing a human immunodeficiency virus infection. Am J Prev Med. 1994 Jan-Feb;10(1):1–4. [PubMed] [Google Scholar]
  6. Hobfoll S. E., Jackson A. P., Lavin J., Britton P. J., Shepherd J. B. Reducing inner-city women's AIDS risk activities: a study of single, pregnant women. Health Psychol. 1994 Sep;13(5):397–403. doi: 10.1037//0278-6133.13.5.397. [DOI] [PubMed] [Google Scholar]
  7. Holmberg S. D. The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. Am J Public Health. 1996 May;86(5):642–654. doi: 10.2105/ajph.86.5.642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Holtgrave D. R., Kelly J. A. Preventing HIV/AIDS among high-risk urban women: the cost-effectiveness of a behavioral group intervention. Am J Public Health. 1996 Oct;86(10):1442–1445. doi: 10.2105/ajph.86.10.1442. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Holtgrave D. R., Pinkerton S. D. Updates of cost of illness and quality of life estimates for use in economic evaluations of HIV prevention programs. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Sep 1;16(1):54–62. doi: 10.1097/00042560-199709010-00009. [DOI] [PubMed] [Google Scholar]
  10. Holtgrave D. R., Qualls N. L., Graham J. D. Economic evaluation of HIV prevention programs. Annu Rev Public Health. 1996;17:467–488. doi: 10.1146/annurev.pu.17.050196.002343. [DOI] [PubMed] [Google Scholar]
  11. Holtgrave D. R., Qualls N. L. Threshold analysis and programs for prevention of HIV infection. Med Decis Making. 1995 Oct-Dec;15(4):311–317. doi: 10.1177/0272989X9501500402. [DOI] [PubMed] [Google Scholar]
  12. Jemmott J. B., 3rd, Jemmott L. S., Fong G. T. Reductions in HIV risk-associated sexual behaviors among black male adolescents: effects of an AIDS prevention intervention. Am J Public Health. 1992 Mar;82(3):372–377. doi: 10.2105/ajph.82.3.372. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kegeles S. M., Hays R. B., Coates T. J. The Mpowerment Project: a community-level HIV prevention intervention for young gay men. Am J Public Health. 1996 Aug;86(8):1129–1136. doi: 10.2105/ajph.86.8_pt_1.1129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kelly J. A., Murphy D. A., Sikkema K. J., Kalichman S. C. Psychological interventions to prevent HIV infection are urgently needed. New priorities for behavioral research in the second decade of AIDS. Am Psychol. 1993 Oct;48(10):1023–1034. doi: 10.1037//0003-066x.48.10.1023. [DOI] [PubMed] [Google Scholar]
  15. Kelly J. A., Murphy D. A., Washington C. D., Wilson T. S., Koob J. J., Davis D. R., Ledezma G., Davantes B. The effects of HIV/AIDS intervention groups for high-risk women in urban clinics. Am J Public Health. 1994 Dec;84(12):1918–1922. doi: 10.2105/ajph.84.12.1918. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kelly J. A., St Lawrence J. S., Diaz Y. E., Stevenson L. Y., Hauth A. C., Brasfield T. L., Kalichman S. C., Smith J. E., Andrew M. E. HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis. Am J Public Health. 1991 Feb;81(2):168–171. doi: 10.2105/ajph.81.2.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kelly J. A., St Lawrence J. S., Hood H. V., Brasfield T. L. Behavioral intervention to reduce AIDS risk activities. J Consult Clin Psychol. 1989 Feb;57(1):60–67. doi: 10.1037//0022-006x.57.1.60. [DOI] [PubMed] [Google Scholar]
  18. Kelly J. A., St Lawrence J. S., Stevenson L. Y., Hauth A. C., Kalichman S. C., Diaz Y. E., Brasfield T. L., Koob J. J., Morgan M. G. Community AIDS/HIV risk reduction: the effects of endorsements by popular people in three cities. Am J Public Health. 1992 Nov;82(11):1483–1489. doi: 10.2105/ajph.82.11.1483. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Laupacis A., Feeny D., Detsky A. S., Tugwell P. X. Tentative guidelines for using clinical and economic evaluations revisited. CMAJ. 1993 Mar 15;148(6):927–929. [PMC free article] [PubMed] [Google Scholar]
  20. Peterson J. L., Coates T. J., Catania J., Hauck W. W., Acree M., Daigle D., Hillard B., Middleton L., Hearst N. Evaluation of an HIV risk reduction intervention among African-American homosexual and bisexual men. AIDS. 1996 Mar;10(3):319–325. doi: 10.1097/00002030-199603000-00011. [DOI] [PubMed] [Google Scholar]
  21. Pinkerton S. D., Abramson P. R. Effectiveness of condoms in preventing HIV transmission. Soc Sci Med. 1997 May;44(9):1303–1312. doi: 10.1016/s0277-9536(96)00258-4. [DOI] [PubMed] [Google Scholar]
  22. Pinkerton S. D., Holtgrave D. R., Valdiserri R. O. Cost-effectiveness of HIV-prevention skills training for men who have sex with men. AIDS. 1997 Mar;11(3):347–357. doi: 10.1097/00002030-199703110-00013. [DOI] [PubMed] [Google Scholar]
  23. Rietmeijer C. A., Kane M. S., Simons P. Z., Corby N. H., Wolitski R. J., Higgins D. L., Judson F. N., Cohn D. L. Increasing the use of bleach and condoms among injecting drug users in Denver: outcomes of a targeted, community-level HIV prevention program. AIDS. 1996 Mar;10(3):291–298. [PubMed] [Google Scholar]
  24. Rotheram-Borus M. J., Koopman C., Haignere C., Davies M. Reducing HIV sexual risk behaviors among runaway adolescents. JAMA. 1991 Sep 4;266(9):1237–1241. [PubMed] [Google Scholar]
  25. St Lawrence J. S., Brasfield T. L., Jefferson K. W., Alleyne E., O'Bannon R. E., 3rd, Shirley A. Cognitive-behavioral intervention to reduce African American adolescents' risk for HIV infection. J Consult Clin Psychol. 1995 Apr;63(2):221–237. doi: 10.1037//0022-006x.63.2.221. [DOI] [PubMed] [Google Scholar]
  26. Valdiserri R. O., Lyter D. W., Leviton L. C., Callahan C. M., Kingsley L. A., Rinaldo C. R. AIDS prevention in homosexual and bisexual men: results of a randomized trial evaluating two risk reduction interventions. AIDS. 1989 Jan;3(1):21–26. [PubMed] [Google Scholar]
  27. Weller S. C. A meta-analysis of condom effectiveness in reducing sexually transmitted HIV. Soc Sci Med. 1993 Jun;36(12):1635–1644. doi: 10.1016/0277-9536(93)90352-5. [DOI] [PubMed] [Google Scholar]

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