Table 2.

Summary of costing and cost-effectiveness studies identified

Intervention, study	Setting & target population	Intervention description	Costing scope and methods	Unit cost (2011 US$)	CERs (2011 US$)	Interpretation and limitations
Male involvement through couple counselling for the prevention of vertical transmission John et al., 2008	Kenya (urban) 1 ANC clinic 10,000 women enrolled in ANC	HCT included health education, pre-test counselling, testing and post-test counselling. Women attending their first antenatal visit were provided information as a group on HIV-1 infection and vertical transmission prevention interventions, and were then asked to return with their partners after 7 days for HCT. Following pre-test counselling, blood was collected for rapid HIV-1 testing on site and results were disclosed on the same day.	Prospective cohort cost and outcome modelling Incremental financial costing, excluding fixed costs such as rental and utilities Provider perspective Bottom-up costing No sensitivity analysis for cost assumptions	Standard VCT: US$0.84 per woman enrolled in ANC Couple VCT: US$0.90 per woman enrolled in ANC	Standard VCT: US$95.40 per infant infection averted US$16.60 per DALY averted Couple VCT: US$98.45 per infant infection averted US$16.60 per DALY averted	Could be a critical enabler for a vertical transmission prevention programme; or for an HIV testing for treatment programme (HIV+) Highly cost-effective (cost per DALY averted<Kenya's GDP per capita=US$790) Sensitivity analyses found that couple VCT was more cost-effective in scenarios with increased uptake and higher HIV prevalence Outcomes for parents not considered, i.e., HIV infections averted among discordant couples or DALYs averted from ART
Community mobilization and gender empowerment for FSWs Vassall et al. (in submission)	India 2 districts 9680 FSWs	This comprehensive HIV prevention programme for high-risk populations had an additional gender-transformative community mobilization component, consisting of the formation of self-help groups, drop-in centres, formation of committees, strengthening of collective action, capacity building, mass events, advocacy and enabling environment.	Empirical, incremental economic costing Modelling of outcomes based on empirical condom use data Provider perspective Combined ingredients approach and top-down Sensitivity analyses conducted for costs	US$18.7– 21 per FSW reached with community mobilization component at least once a year 8.9–19% of the HIV prevention programme was spent on the community mobilization component	US$13.2–19.1 per DALY averted – no ART Cost saving on average with ART	• Could be a critical enabler to a key population (FSW) programme (HIV+) • Highly cost-effective (cost per DALY averted<India's GDP per capita=US$1330) • If ART cost savings are included (assuming 21–40% ART coverage) the intervention becomes cost saving
Female condom programme for commercial sex workers Marseille et al., 2001	South Africa Rural population of 3,100,000	A female condom programme serving 1000 commercial sex workers.	Modelled incremental financial costs and HIV treatment cost savings Provider perspective Bottom-up costing Sensitivity analyses for cost assumptions, HIV prevalence among sex workers and clients, and number of clients.	US$0.86 per female condom promoted and distributed (US$0.43–1.72) (US$0.03–0.05 per male condom distributed)a US$5.2 per FSW reached (US$199 per FSW reached)a	US$61.28–762.70 per HIV case averted	Could be a critical enabler of a condom promotion and distribution programme; or a FSW programme (HIV+) Highly cost-effective: US$32 (no ART)— 56 (ART) per DALY averted in South Africa<South Africa's GDP per capita=US$6090 (excluding treatment cost savings) Limitations: modelled costs
Female condom promotion and distribution Thomsen et al., 2006	Kenya (urban) 1 NGO site 210 FSWs 2382 FSWs (scale-up)	Adding female condom promotion to a male condom programme providing peer education and IEC materials, as well as distributing female condoms.	Empirical (1 & 2) and modelled (3) costs Incremental, financial costing Provider perspective Bottom-up costing	US$305 per participant US$189 per participant (scale-up) US$100 per participant (scale-up, less substitution) (US$29 per FSW reached)a	US$4009 per additional consistent condom user US$2559 per additional consistent condom user US$1350 per additional consistent condom user (scale-up, less substitution)	Could be part of condom promotion; key populations; or behaviour change programmes (HIV+) Unclear whether cost-effective, as CER not comparable to international standards, but less cost-effective than male condom promotion and high degree of substitution expected where male condom use is high Limitations: modelled costs
Expanded female condom distribution Dowdy et al., 2006	South Africa Brazil Target population not available	Female condom acquisition, distribution, training and education	Modelled costs and outcomes for low, medium and high volumes	US$0.29–1.21 per condom distributed US$0.28–0.82 per condom distributed ((1) US$0.03–0.05 and (2) $0.14–0.25 per male condom distributed)a	US$431–1152 per HIV infection averted US$10,287–23,827 per HIV infection averted (Point estimates in different scenarios)	Could be a critical enabler of a condom promotion and distribution programme (HIV+) Highly cost-effective in both countries: US$24 (no ART)– 49 (ART) per DALY averted in South Africa<South Africa's GDP per capita=US$6090; and US$880 (no ART)–1499 (ART) per DALY averted in Brazil<Brazil's GDP per capita=US$9390) Limitations: modelled costs, likely to underestimate demand creation costs
Peer education to transform gender norms Pulerwitz et al., 2006	Brazil 2 NGO sites 258 young men 250 young men	Two models: Interactive group education sessions for young men led by adult male facilitators Group education+community-wide “lifestyle” social marketing campaign to promote condom use, using gender-equitable messages.	Empirical, full financial costing Provider perspective Top-down approach	US$158 per participant US$106 per participant US$5.00 per participant per hour of group education ($3.80–6.20) (US$3.40 per employee reached through peer education)a	Not available See effectiveness Table (Pulerwitz et al., 2006)	• Could be a critical enabler of behaviour change programmes, with gender equity messaging (HIV+) • CERs were not estimated in this study, so it is unclear if it is cost-effective • Limitations: excludes the cost of condoms and other donated inputs, no sensitivity analysis
Mass media edutainment for HIV/AIDS and GBV Muirhead et al., n.d.	South Africa Black and coloured adult population (aged 15–49)	The Soul City 4th series was a multimedia edutainment programme producing television drama, radio drama and print materials serialised in 10 national newspapers and booklets around several themes, including HIV/AIDS and violence against women.	Empirical, full economic costing National-level modelling Provider perspective	US$0.04; $0.28 and $0.35 per person reached by radio, print and television US$5.2 million per campaign (40% for Violence against Women theme) (US$12.7 million per HIV mass media campaign)a	US$0.56 per weighted effect on HIV-related action ($0.36–0.77)	Could be an enhanced critical enabler with combined HIV and GBV messaging (HIV+) Unclear whether cost-effective, as CER not comparable to international standards 46% (television), 31% (radio) and 34% (print) of total unit cost is for VAW components
HIV post-exposure prophylaxis for survivors of sexual assault Christofides et al., 2009	South Africa 2 sites (public facility-based and NGO community-based) Sexual assault survivors	Both models of care provide health and psychosocial support, including a medico-legal examination, HIV testing and counselling, STD treatment, comfort kit, post-exposure prophylaxis therapy for HIV negative survivors. The protocol	Empirical (1) modelling at national level (2, 3) Economic full and incremental costing Provider perspective Mixed bottom-up and	US$819 per survivor ($480–1149) US$402 (full) US$65 (incremental for PEP) (US$29.53 per PEP kit)a	US$50,228 net cost per HIV transmission averted without ART ($5924–972,044) US$37,470 net cost per HIV transmission averted with full access to ART ($6833–959,287) US$2311 net cost per life year gained without ART ($272–44,733) US$2149 net cost per life year gained with full access to ART (−$392–55,005)	Could be a development synergy with GBV programmes (Gender+) HIV component=65/402=16% of total, or additional 19% of basic post-rape service package Full intervention is highly cost-effective: US$2120 (no ART)– 2729 (ART) per DALY averted<South Africa's GDP per capita=US$6090
		includes follow-up monitoring visits for counselling, HIV and pregnancy testing and women are supported through the court process.	top-down costing Includes patient-level, site and central-level costs
Comprehensive post-rape services Kim et al., 2009	South Africa (rural) 1 public district hospital 409 rape survivors	Refentse model: five-part intervention model, including the establishment of a sexual violence advisory committee, the formulation of a hospital rape management policy, a training workshop for service providers, designated examining room, and community awareness campaigns.	Empirical, incremental economic costing Provider perspective Mixed top-down (facility-level costs) and bottom-up (patient-level costs)	US$216 per case US$62.60 per case (excl. start-up development costs) (US$29.53 per PEP kit)a	Not available	Could be a development synergy with GBV (Gender) Not a cost-effectiveness study Incremental HIV investment is not clearly distinguished from total investment
Comprehensive post-rape services Kilonzo et al., 2009	Kenya 3 public health centres 784 rape survivors (43% were children <15 years)	The standard of care included clinical evaluation and documentation, clinical management, counselling and referral mechanisms. Targeted training that was knowledge-, skills- and values-based was provided to clinicians, laboratory personnel and trauma counsellors and coordination mechanisms established with the local police.	Modelled (over one year) Financial costing (excludes start-up capital costs) Provider perspective Top-down	US$30.10 per survivor (US$38.75 per PEP kit)a	Not available	Could be a development synergy with GBV (Gender) Not a cost-effectiveness study Incremental HIV investment is not clearly distinguished from total investment Limitations: modelled costs, excludes start-up and capital costs, no sensitivity analysis
Intervention with Microfinance for AIDS & Gender Equity (IMAGE) Jan et al., 2011	South Africa (rural) 12 loan centres • 855 poor women in initial two-year trial phase • 2598 poor women in two-year scale-up phase	A gender and HIV training component was added on to a microfinance intervention. The “sisters for life” training curriculum consisted of 10 fortnightly 1-h training and discussion sessions addressing issues such as gender roles, cultural beliefs, relationships, communication, IPV and HIV.	Empirical Incremental, economic costing Provider perspective Ingredients approach	US$50.90 per participant US$15.30 per participant	US$841 per woman with IPV-free year gained US$9107 per IPV-related DALY US$252 per woman with IPV-free year gained US$2733 per IPV-related DALY	Could be a development synergy with economic empowerment interventions for women (Gender+) Unclear whether cost-effective for HIV, as CER is not for an HIV outcome Multiple outcomes not included in CER, i.e., reductions in HIV risk behaviours, increased reported condom use, increased household revenue, improved gender attitudes
Zomba cash transfer programme to keep girls in school Baird et al., 2012	Malawi (rural) 2 NGOs 1225 never-married girls aged 13–22 over 18 months	Monthly cash transfers between $4 and 10 provided to households with girls in school or having dropped out at baseline, split between guardian and girl. Conditional group (baseline schoolgirls and dropouts): payment conditional upon 80% school attendance. Unconditional group (baseline schoolgirls): payment received if girl came to the cash point	Empirical Incremental, partial, financial costing Provider perspective Mixed bottom-up (direct) and top-down (administrative costs and fees) costing	US$231 per girl (trial) US$92 per girl (at scale)	US$12,831 per HIV infection averted (trial) US$5132 per HIV infection averted (at scale)	Could be a development synergy with girls’ education or social protection (Gender+) Highly cost-effective at scale cost and with no ART assumption: US$212 per DALY averted (<Malawi's GDP per capita=US$330) Cost-effective in other scenarios (US$365–912 per DALY averted) assuming WHO's upper threshold (<3×GDP per capita=US$990) Multiple outcomes not considered in CERs, i.e., reduced HSV-2 prevalence; reduced teen pregnancies; increased school enrolment and attendance
School support for orphan girls Miller et al., 2013	Zimbabwe 183 orphan girls over 3.3 years	School support, including fees, uniforms and school supplies. Female teachers at each intervention primary school were selected and trained as helpers (approximately one helper to 10 participants) to monitor school attendance and intervene as needed, but not to provide special HIV information or life skills training.	Empirical unit costs, modelled ART cost savings and return on education for CER Incremental, economic costing Provider perspective Bottom-up costing	US$1486 per girl (boarders and non-boarders) US$981 girl (non-boarder)	US$6.05 per QALY gained (ranging from −$544 to $2032 per QALY gained in sensitivity analyses)	Could be development synergy with education or social protection (Gender) Highly cost-effective (<Zimbabwe's GDP per capita=US$460), if OVC morbidity is considered an HIV outcome Multiple outcomes considered and monetized on the cost side (return on additional education, ART cost savings)
Education and HIV interventions Duflo et al., 2006	Kenya 328 schools in study (240 schools in intervention groups) 70,000 school girls and boys	Three interventions: Training teachers in the HIV/AIDS education curriculum designed for primary schools by the Kenyan government Reducing the cost of education by providing free uniforms Informing teenagers about variation in HIV rates by age and gender	Empirical incremental economic costing Provider perspective Top-down approach	US$5.50 per girl reached US$11.70 per girl reached US$1.70 per girl reached (global range US$11–27 per pupil receiving AIDS education)a	US$1006 per pregnancy averted US$863 per pregnancy averted US$105 per pregnancy averted	Could be a development synergy with education, in particular school-based AIDS education and youth programmes (Gender and Gender+) Unclear whether cost-effective for HIV, as CER is not for an HIV outcome Limitations: no detailed cost breakdown, no sensitivity analyses for costs

^aUnit costs from the investment framework model (Schwartlander et al., 2011) adjusted to 2011 US$. These are only indicated where available in the same unit and where the study identified does not already compare the incremental cost of the intervention. GBV=gender-based violence; GDP=gross domestic product; ART=antiretroviral therapy; CER=cost-effectiveness ratio; FSW=female sex worker; IPV=intimate partner violence.