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AIDS initiative prevented more than 100,000 new infections in India
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Implementation of the India AIDS Initiative, Avahan, reduced HIV prevalence at the population-level by preventing more than 100,000 new HIV infections during the first 5 years, according to new findings published in The Lancet.
Increased intensity of the program was significantly associated with lower HIV prevalence in Andhra Pradesh (P=.004), Karnataka (P=.004) and Maharashtra (P=.008) districts. Conversely, the association was not significant in Tamil Nadu (P=.06), Manipur (P=.62) and Nagaland (P=.67) districts.
“A well-planned HIV prevention program can be an economic and effective means to combat HIV, and by targeting the people at highest risk, a program can benefit the larger population as well,” Marie Ng, PhD, assistant professor at the University of Hong Kong, told Infectious Disease News. “On average, the cost per HIV infection averted was $2,500, making it cost-effective compared to the amount of care required to treat a patient with AIDS. In recent years, increased funding has been shifted to HIV treatment, and this study provides support for the idea that we should also be funding behavioral interventions and other prevention efforts.”
Ng and colleagues assessed the population-level effect of the first phase of the HIV-prevention initiative from 2003 to 2008 among clinic attendees aged 15 to 49 years.
Overall, the HIV initiative averted approximately 100,178 new HIV infections (95% CI, 25,897-207,713) during the study period.
“The program targets the high-risk population, including female sex workers, their partners and clients, injecting drug users, men who have sex with men and truck drivers,” Ng said. “By targeting high-risk groups, the program was able to reduce HIV rates in the broader population. This has big implications for countries facing similar challenges from HIV. The key will be to understand the specifics of the populations in each area and to design a program with those specifics in mind.”
In an accompanying editorial, Ties Boerma, MD, PhD of WHO in Switzerland, and Isabelle de Zoysa, MD MPH, of Lungarno Guicciardini in Florence, Italy, wrote: “The report by Ng and colleagues focuses exclusively on the accountability aspect of evaluation, but not the learning dimension. To learn from evaluation, it is necessary to unravel the causal pathway and carefully consider the implementation successes and failures of the main interventions. Pathway analysis is also necessary to enhance our confidence in the plausibility of the results.” – by Ashley DeNyse
For more information:
- Boerma T. Lancet. 2011;doi:10.1016/S0140-6736(11)61519-5.
- Ng M. Lancet. 2011;doi:10.1016/S0140-6736(11)61390-1.
Disclosure: This research was funded by the Bill & Melinda Gates Foundation.
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