Top

Published in:

Open Access 01-06-2016 | Brief Report

Economic Evaluation of Community-Based HIV Prevention Programs in Ontario: Evidence of Effectiveness in Reducing HIV Infections and Health Care Costs

Authors: Stephanie K. Y. Choi, David R. Holtgrave, Jean Bacon, Rick Kennedy, Joanne Lush, Frank McGee, George A. Tomlinson, Sean B. Rourke

Published in: AIDS and Behavior | Issue 6/2016

Abstract

Investments in community-based HIV prevention programs in Ontario over the past two and a half decades are assumed to have had an impact on the HIV epidemic, but they have never been systematically evaluated. To help close this knowledge gap, we conducted a macro-level evaluation of investment in Ontario HIV prevention programs from the payer perspective. Our results showed that, from 1987 to 2011, province-wide community-based programs helped to avert a total of 16,672 HIV infections, saving Ontario’s health care system approximately $6.5 billion Canadian dollars (range 4.8–7.5B). We also showed that these community-based HIV programs were cost-saving: from 2005 to 2011, every dollar invested in these programs saved about $5. This study is an important first step in understanding the impact of investing in community-based HIV prevention programs in Ontario and recognizing the impact that these programs have had in reducing HIV infections and health care costs.

Farnham PG, Gopalappa C, Sansom SL, Hutchinson AB, Brooks JT, Weidle PJ, et al. Updates of lifetime costs of care and quality-of-life estimates for HIV-infected persons in the United States: late versus early diagnosis and entry into care. J Acquir Immune Defic Syndr. 2013;64:183–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23615000. Cited 17 Apr 2015.

Aspinall EJ, Nambiar D, Goldberg DJ, 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;43:235–48. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24374889. Cited 16 Apr 2015.

Crepaz N, Lyles CM, Wolitski RJ, Passin WF, Rama SM, Herbst JH, et al. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS. 2006;20:143–57. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16511407. Cited 16 Apr 2015.

Needle RH, Burrows D, Friedman SR, Dorabjee J, Touzé G, Badrieva L, et al. Effectiveness of community-based outreach in preventing HIV/AIDS among injecting drug users. Int J Drug Policy. 2005;16:45–57. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0955395905000964. Cited 14 Apr 2015.

Qiao S, Li X, Stanton B. Social support and HIV-related risk behaviors: a systematic review of the global literature. AIDS Behav. 2014;18:419–41. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3946791&tool=pmcentrez&rendertype=abstract. Cited 22 Mar 2015.

Bateganya MH, Amanyeiwe U, Roxo U, Dong M. Impact of support groups for people living with HIV on clinical outcomes. J Acquir Immune Defic Syndr. 2015;68:S368–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25768876. Cited 16 Apr 2015.

LaCroix JM, Snyder LB, Huedo-Medina TB, Johnson BT. Effectiveness of mass media interventions for HIV prevention, 1986–2013. J Acquir Immune Defic Syndr. 2014;66:S329–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25007204. Cited 16 Apr 2015.

Herbst JH, Beeker C, Mathew A, McNally T, Passin WF, Kay LS, et al. The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: a systematic review. Am J Prev Med. 2007;32:S38–67. Available from: http://www.sciencedirect.com/science/article/pii/S0749379706005551. Cited 14 Apr 2015.

Johnson WD, Diaz RM, Flanders WD, Goodman M, Hill AN, Holtgrave D, et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database Syst Rev. 2008;CD001230. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18646068. Cited 5 Mar 2014.

10.

Charania M. Efficacy of structural-level condom distribution interventions: a meta-analysis of U.S. and international studies, 1998–2007. AIDS Behav. 2011;15:1283–97.CrossRefPubMedPubMedCentral

11.

Charania MR, Marshall KJ, Lyles CM, Crepaz N, Kay LS, Koenig LJ, et al. Identification of evidence-based interventions for promoting HIV medication adherence: findings from a systematic review of U.S.-based studies, 1996–2011. AIDS Behav. 2014;18:646–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24043269. Cited 8 Apr 2015.

12.

Willis S, Castel AD, Ahmed T, Olejemeh C, Frison L, Kharfen M. Linkage, engagement, and viral suppression rates among HIV-infected persons receiving care at medical case management programs in Washington, DC. J Acquir Immune Defic Syndr. 2013;64:S33–41. Available from:/pmc/articles/PMC3844615/?report = abstract. Cited 16 Apr 2015.

13.

AIDS service organizations, AIDS and Hepatitis C Programs, the Ontario Ministry of Health and Long-Term Care, and the Public Health Agency of Canada, Ontario Region. Ontario Community HIV/AIDS Reporting Tool.

14.

Public Health Agency of Canada. Evaluation of the Federal Initiative to Address HIV/AIDS in Canada 2008-09 to 2012-13. 2013; Available from: http://www.phac-aspc.gc.ca/about_apropos/evaluation/reports-rapports/2013-2014/diaha-idlvs/index-eng.php.

15.

Holtgrave D. Threshold analysis and programs for prevention of HIV infection. Med Decis Mak. 1995;15:311–7.CrossRef

16.

Holtgrave DR. Handbook of economic evaluation of HIV prevention programs. New York: Plenum Press; 1998.

17.

Farnham PG, Holtgrave DR, Sansom SL, Hall HI. Medical costs averted by HIV prevention efforts in the United States, 1991-2006. J Acquir Immune Defic Syndr. 2010;54:565–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20647830. Cited 14 Jan 2015.

18.

Holtgrave DR. Costs and consequences of the US Centers for Disease Control and Prevention’s recommendations for opt-out HIV testing. PLoS Med. 2007;4:e194.CrossRefPubMedPubMedCentral

19.

Holtgrave DR. On the epidemiologic and economic importance of the National AIDS Strategy for the United States. J Acquir Immune Defic Syndr. 2010;55:139–42.CrossRefPubMed

20.

Holtgrave DR, Kim JJ, Adkins C, Maulsby C, Lindsey KD, Johnson KM, et al. Unmet HIV service needs among Black men who have sex with men in the United States. AIDS Behav. 2014;18:36–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23892769. Cited 6 Mar 2014.

21.

Holtgrave DR, Hall HI, Wehrmeyer L, Maulsby C. Costs, Consequences and feasibility of strategies for achieving the goals of the National HIV/AIDS strategy in the United States: a closing window for success? AIDS Behav. 2012;16:1365–72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22610372. Cited 8 Aug 2012.

22.

Holtgrave DR, Kates J. HIV incidence and CDC’s HIV prevention budget: an exploratory correlational analysis. Am J Prev Med. 2007;32:63–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17184960. Cited 15 Aug 2012.

23.

Kessler J, Myers JE, Nucifora KA, Mensah N, Kowalski A, Sweeney M, et al. Averting HIV infections in New York City: a modeling approach estimating the future impact of additional behavioral and biomedical HIV prevention strategies. PLoS One. 2013;8:e73269. Available from: http://dx.plos.org/10.1371/journal.pone.0073269. Cited 6 Mar 2014.

24.

Public Health Agency of Canada. HIV and AIDS in Canada: Surveillance Report to December 31, 2009—Public Health Agency of Canada. 2009.

25.

Remis R, Swantee C, Liu J. Report on HIV/AIDS in Ontario 2001-2009. Toronto: Ontario Ministry of Health and Long-Term Care; 2001.

26.

Statistics Canada. Consumer price index. Ottawa: Statistics Canada; 2012.

27.

Drummond MF, O’Brien B, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford medical Publications, Oxford University press; 1997.

28.

Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in health and medicine. 1st ed. New York: Oxford University Press; 1996.

29.

Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. 1995;346:530–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7658778. Cited 28 May 2015.

30.

Phillips AN, Cambiano V, Nakagawa F, Brown AE, Lampe F, Rodger A, et al. Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic. PLoS One. 2013;8:e55312. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3574102&tool=pmcentrez&rendertype=abstract. Cited 12 Feb 2014.

31.

Levy AR, James D, Johnston KM, Hogg RS, Harrigan PR, Harrigan BP, et al. The direct costs of HIV/AIDS care. Lancet Infect Dis. 2006;6:171–7. Available from: http://www.sciencedirect.com/science/article/pii/S1473309906704133. Cited Dec 23 2011.

32.

Krentz HB, Auld MC, Gill MJ. The changing direct costs of medical care for patients with HIV/AIDS, 1995-2001. Can Med Assoc J. 2003;169:106–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12874156. Cited 23 Dec 2011.

33.

Krentz HB. Cost of medical care for HIV-infected patients within a regional population from 1997 to 2006. HIV Med. 2008;9:721–30.CrossRefPubMed

34.

Krentz HB, Auld MC, Gill MJ. The high cost of medical care for patients who present late (CD4 < 200 cells/microL) with HIV infection. HIV Med. 2004;5:93–8.CrossRefPubMed

35.

Beck EJ, Harling G, Gerbase S, DeLay P. The cost of treatment and care for people living with HIV infection: implications of published studies, 1999–2008. Curr Opin HIV AIDS. 2010;5:215–24.CrossRefPubMed

36.

Albert T, Williams G. Economic burden of HIV/AIDS in Canada. Canadian Policy Research Network; 1998.

37.

Dodds C, Colman R, Amaratunga C, Wilson J. The cost of HIV/AIDS in Canada. Genuine Progress Index for Atlantic Canada; 2001.

38.

Holtgrave DR, Pinkerton SD. 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;16:54–62.

39.

Schackman BR, Gebo KA, Walensky RP, Losina E, Muccio T, Sax PE, et al. The lifetime cost of current human immunodeficiency virus care in the United States. Med Care. 2006;44:990–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17063130. Cited 2011 Dec 23.

40.

The Cabinet Office. A guide to social return on investment [Internet]. 2012. Available from: http://www.thesroinetwork.org/publications/doc_details/241-a-guide-to-social-return-on-investment-2012. Cited 22 Apr 2015.

41.

Edwards RT, Charles JM, Lloyd-Williams H. Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues. BMC Public Health. 2013;13:1001. Available from: http://www.biomedcentral.com/1471-2458/13/1001. Cited 31 Mar 2015.

42.

Bank of Canada. Annual average exchange rates [Internet]. 2011. Available from: http://www.bankofcanada.ca/rates/exchange/annual-average-exchange-rates/.

43.

Allman D, Myer T, Cockerill R. Concepts, definition, and models for community-based HIV prevention research in Canada. Canada: HIV Social, Behaviour, and Epidemiological Studies Unit; 1997.

44.

Plummer D, Irwin L. Grassroots activities, national initiatives and HIV prevention: clues to explain Australia’s dramatic early success in controlling the HIV epidemic. Int J STD AIDS. 2006;17:787–93.CrossRefPubMed

45.

Roberts G, Grimes K. Return on investment: mental health promotion and mental illness prevention. 2011. Available from: http://ccednet-rcdec.ca/en/node/12032. Cited Apr 22 2015.

46.

Ruger JP, Emmons KM. Economic evaluations of smoking cessation and relapse prevention programs for pregnant women: a systematic review. Value Health. 2015;11:180–90. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2732023&tool=pmcentrez&rendertype=abstract. Cited 21 Apr 2015.

47.

Bhaumik U, Norris K, Charron G, Walker SP, Sommer SJ, Chan E, et al. A cost analysis for a community-based case management intervention program for pediatric asthma. J Asthma 2013;50:310–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23311526. Cited 21 Apr 2015.

48.

Hanefeld J, Bond V, Seeley J, Lees S, Desmond N. Considerations for a human rights impact assessment of a population wide treatment for HIV prevention intervention. Dev World Bioeth. 2013. Available from: http://doi.wiley.com/10.1111/dewb.12038. Cited 11 May 2014.

49.

Merson MH, O’Malley J, Serwadda D, Apisuk C. The history and challenge of HIV prevention. Lancet. 2008;372:475–88. Available from: http://www.sciencedirect.com/science/article/pii/S0140673608608843. Cited 28 Apr 2014.

50.

Padian NS, McCoy SI, Karim SSA, Hasen N, Kim J, Bartos M, et al. HIV prevention transformed: the new prevention research agenda. Lancet. 2011;378:269–78. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3606928&tool=pmcentrez&rendertype=abstract. Cited 30 Apr 2014.

51.

Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN. Combination HIV prevention: significance, challenges, and opportunities. Curr HIV/AIDS Rep. 2011;8:62–72. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3036787&tool=pmcentrez&rendertype=abstract. Cited 18 May 2014.

52.

Rausch DM, Grossman CI, Erbelding EJ. Integrating behavioral and biomedical research in HIV interventions: challenges and opportunities. J Acquir Immune Defic Syndr. 2013;63(Suppl 1):S6–11.CrossRefPubMed

53.

Kulkarni SP, Shah KR, Sarma K V, Mahajan AP. Clinical uncertainties, health service challenges, and ethical complexities of HIV “test-and-treat”: a systematic review. Am. J Public Health [Internet]. 2013;103:e14–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23597344. Cited 13 Apr 2015.

54.

Lombardo AP, Léger YA. Thinking about “Think Again” in Canada: assessing a social marketing HIV/AIDS prevention campaign. J Health Commun. 2007;12:377–97. Available from: http://www.scopus.com/inward/record.url?eid=2-s2.0-34250160158&partnerID=tZOtx3y1. Cited 13 Apr 2015.

55.

Suthar AB, Ford N, Bachanas PJ, Wong VJ, Rajan JS, Saltzman AK, et al. Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS Med. 2013;10:e1001496. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3742447&tool=pmcentrez&rendertype=abstract. Cited 7 Apr 2015.

56.

57.

Huang Y-LA, Lasry A, Hutchinson AB, Sansom SL. A systematic review on cost effectiveness of HIV prevention interventions in the United States. Appl Health Econ Health Policy. 2014;13:149–56. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25536927. Cited 16 Apr 2015.

58.

Shannon K, Bright V, Allinott S, Alexson D, Gibson K, Tyndall MW. Community-based HIV prevention research among substance-using women in survival sex work: the Maka Project Partnership. Harm Reduct J. 2007;4:20. Available from: http://www.harmreductionjournal.com/content/4/1/20. Cited 14 Apr 2015.

59.

Lombardo AP, Léger YA. Thinking about “Think Again” in Canada: assessing a social marketing HIV/AIDS prevention campaign. J Health Commun. 2007;12:377–97. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17558789. Cited 13 Apr 2015.

60.

Leaver CA, Allman D, Meyers T, Veugelers PJ. Effectiveness of HIV prevention in Ontario, Canada: a multilevel comparison of bisexual men. Am J Public Health. 2004;94:1181–5. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1448418&tool=pmcentrez&rendertype=abstract. Cited 13 Apr 2015.

61.

Rolland M, Edlefsen PT, Larsen BB, Tovanabutra S, Sanders-Buell E, Hertz T, et al. Increased HIV-1 vaccine efficacy against viruses with genetic signatures in Env V2. Nature. 2012;490:417–20.CrossRefPubMedPubMedCentral

62.

Barash EA, Golden M. Awareness and use of HIV pre-exposure prophylaxis among attendees of a Seattle Gay pride event and sexually transmitted sisease clinic. AIDS Patient Care STDS. 2010;24(11):689–91.CrossRefPubMed

63.

Milloy M-J, Marshall BDL, Montaner J, Wood E. Housing status and the health of people living with HIV/AIDS. Curr HIV/AIDS Rep. 2012;9(4):364–74. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3693560&tool=pmcentrez&rendertype=abstract.

64.

Aidala A, Cross JE, Stall R, Harre D, Sumartojo E. Housing status and HIV risk behaviors: implications for prevention and policy. AIDS Behav. 2005;9(3):251–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16088369.

Title: Economic Evaluation of Community-Based HIV Prevention Programs in Ontario: Evidence of Effectiveness in Reducing HIV Infections and Health Care Costs
Authors: Stephanie K. Y. Choi
David R. Holtgrave
Jean Bacon
Rick Kennedy
Joanne Lush
Frank McGee
George A. Tomlinson
Sean B. Rourke
Publication date: 01-06-2016
Publisher: Springer US
Published in: AIDS and Behavior / Issue 6/2016
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-015-1109-8

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2016

Individual-Level, Partnership-Level, and Sexual Event-Level Predictors of Condom Use During Receptive Anal Intercourse Among HIV-Negative Men Who Have Sex with Men in Los Angeles

How Many Sexual Partners of an Individual Need to Be Evaluated to Capture HIV/STI Risk Behavior in a Study?

Adolescent HIV Risk Reduction in the Bahamas: Results from Two Randomized Controlled Intervention Trials Spanning Elementary School Through High School

Venues for Meeting Sex Partners and Partner HIV Risk Characteristics: HIV Prevention Trials Network (HPTN064) Women’s HIV Seroincidence Study (ISIS)

Young Men’s Social Network Characteristics and Associations with Sexual Partnership Concurrency in Tanzania

Randomized Controlled Trial of an Internet Application to Reduce HIV Transmission Behavior Among HIV Infected Men Who have Sex with Men

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage