| Many donors and countries are striving to respond to the HIV/AIDS
epidemic by implementing prevention programmes. However, the
resources available for providing these activities relative
to needs are limited. Hence, decision-makers must choose among
various types of interventions. Cost information, both measures
of cost and cost-effectiveness, serves as a critical input into
the processes of setting priorities and allocating resources
efficiently. This paper reviews the cost and cost-effectiveness
evidence base of HIV/AIDS prevention programmes in low- and
middle-income countries (LMICs). None of the studies found have
complete cost data for a full range of HIV/AIDS prevention programmes
in any one country. However, the range of studies highlight
the relative emphasis of different types of HIV/AIDS prevention
strategies by region, reflecting the various modes of transmission
and hence, to a certain extent, the stage of the epidemic. The
costing methods applied and results obtained in this review
give rise to questions of reliability, validity and transparency.
First, not all of the studies report the methods used to calculate
the costs, and/or do not provide all the necessary data inputs
such that recalculation of the results is possible. Secondly,
methods that are documented vary widely, rendering different
studies, even within the same country and programme setting,
largely incomparable. Finally, even with consistent and replicable
measurement, the results as presented are generally not comparable
because of the lack of a common outcome measure. Therefore,
the extent to which the available cost and cost-effectiveness
evidence base on HIV/AIDS prevention strategies can provide
guidance to decision-makers is limited, and there is an urgent
need for the generation of this knowledge for planning and decision-making. |
