ASSESSMENT OF EFFICIENCY OF PROGRAMS OF COMPREHENSIVE PREVENTION OF HIV-INFECTION FROM THE POINT OF VIEW OF THE PREVENTION OF LOSS OF YEARS, CUSTOMIZED FOR DISABILITY

Abstract

Purpose of the study. To evaluate the efficiency of the prevention programs aimed at the prevention of the spread of HIV infection, represent the it in disabled adjusted life years (DALY) and compare the efficiency with the prevention and treatment costs. Material and methods. Results of the panel study executed in 2006-2013 in 10 regions of Russian Federation in HIV infection risk groups (4 waves). The total number of include participants accounted of 9891. The study protocol included the detailed survey for the risk behavior and HIV testing. The obtained results of the study were used to calibrate the dynamic (Markov) model of the effect of the prevention on the length of the quality-adjusted life and treatment cost. The cost of the prevention was estimated on the base of reporting documents of prevention programs. Results. Programs of the comprehensive prevention of HIV-infection, among injecting drug users give rise in the significant decrease in the HIV incidence. The evaluation of the effect of prevention in frameworks of a multidimensional model shows odds ratio to be of 0.56 (95% CI = 0.40-0.78). This relative reduction of the incidence corresponds to the absolute incidence decrease from 3.98 per 100 person-years, among those not participating in prevention programs (95% CI: 3.37-4.69) to 2.22 per 100 person-years (95% CI: 1.89-2.62) among participants. This effect of the prevention leads to averting losses of 0.75-1.1 DALY per person, with most savings from the diminishing of the disability. In most plausible scenario this results in cost saving with return on the investment of 40 kopeks per rouble invested in prevention. Conclusion. Comprehensive programs of HIV prevention in Russian Federation possess of the significant effectiveness and under plausible assumptions are cost-saving. When discussing financing preventive measures they should be evaluated on real effectiveness and cost.

Keywords

HIV infection / prevention / health economics / disability adjusted life years / cost-utility

References

[1] Александрова Г.А., Лебедев Г.С., Огрызко Е.В., Кадулина Н.А. Беляева И.М. Авдеева Л.Н. и др. Социально значимые заболевания населения России в 2013 году. М.: Министерство здравоохранения Российской Федерации, Департамент мониторинга, анализа и стратегического развития здравоохранения, ФГБУ «Центральный научно-исследовательский институт организации и информатизации здравоохранения» Минздрава России, 2014.

[2] Покровский В.В., Ладная Н.Н., Тушина О.И., Буравцова Е.В. ВИЧ-инфекция. Информационный бюллетень № 40. М.: Федеральный научно-методический центр по профилактике и борьбе со СПИДом; 2015.

[3] Баринова А.Н. Обоснование концептуальной модели профилактики социально-значимых заболеваний, опасных для окружающих. Комплексная оценка эффективности профилактики в группах риска на примере ВИЧ-инфекции. СПб.: СПб ИОЗ; 2016.

[4] Баринова А.Н., Плавинский С.Л., Виноградова Н.Х. Влияние программ комплексной профилактики ВИЧ-инфекции на опасное поведение лиц, употребляющих инъекционные наркотики, в ряде регионов Российской Федерации. Российский семейный врач. 2014; 18(4): 18-23.

[5] Kawichai S., Celentano D.D., Vongchak T., Beyrer C., Suriyanon V., Razak M.H. et al. HIV voluntary counseling and testing and HIV incidence in male injecting drug users in northern Thailand: evidence of an urgent need for HIV prevention. J. Acquir. Immune Defic. Syndr. 2006; 41(2): 186-93.

[6] Niccolai L.M., Verevochkin S.V., Toussova O.V., White E., Barbour R., Kozlov A.P., Heimer R. Estimates of HIV incidence among drug users in St. Petersburg, Russia: continued growth of a rapidly expanding epidemic. Eur. J. Publ. Hlth. 2011; 21: 613-9.

[7] Salomon J.A., Haagsma J.A., Davis A., de Noordhout C., Polinder S., Havelaar A. et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob. Hlth. 2015; 3(11): e712-23.

[8] Ortblad K.F., Lozano R., Murray C.J. The burden of HIV: insights from the Global Burden of Disease Study 2010. AIDS. 2013; 27(13): 2003-17.

[9] Баринова А.Н., Плавинский С.Л. Оценка стоимости предотвращенного случая ВИЧ-инфекции для упрощенного анализа затратной эффективности профилактических мероприятий. Медицина. 2016; (4): 13-21.

[10] Johri M., Ako-Arrey D. The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review. Cost Effect. Resour Alloc. 2011; 9: 3.

[11] Fernandes S., Sicuri E., Halimatou D., Akazili J., Boiang K., Chandramohan D. et al. Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial. Malar. J. 2016; 15(1): 493.

[12] Chanthavilay P., Reinharz D., Mayxay M., Phongsavan K. et al. Economic evaluation of screening strategies combined with HPV vaccination of preadolescent girls for the prevention of cervical cancer in vientiane, Lao PDR. PLoS One. 2016; 11(9): e0162915.

[13] Macroeconomics and Health: Investing in Health for Economic Development / Ed. H. Steele. Geneva: WHO; 2001.

[14] Aspinall E.J., Nambiar D., Goldberg D.J., Hickman M., Weir A., Van Velzen E. et al. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. Int. J. Epidemiol. 2014; 43(1): 235-48.

[15] Wilson D.P., Donald B., Shattock A.J., Wilson D., Fraser-Hurt N. The cost-effectiveness of harm reduction. Int. J. Drug Policy. 2015; 26(Suppl. 1): 5-11.

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