Impact and Economic Evaluations of a Combination Prevention Program for Men Who Have Sex with Men in Mexico
BACKGROUND:
Despite
the high-profile support for combination prevention programmes (CPPs) since
2008, there is little rigorous evidence on their impact and cost-effectiveness.
In 2010, Mexico received funds from the Global Fund to implement a series of
behavioural, biomedical, and structural interventions over 3 years targeted to
men who have sex with men. The aims of the study were to estimate the impact of
the programme across a range of outcomes and cost-effectiveness.
METHODS:
A
quasi-experiment was designed before the implementation of the CPP, in which 24
cities were randomly selected for impact evaluation and 12 pairs of cities were
matched. In practice, though, implementation of the programme was staggered
over 1 year. Therefore, we used two different approaches to estimate impact: a
difference-in-difference estimation comparing both groups and a dose-response
approach using time exposure to the programme at the city level.
FINDINGS:
Results
from the difference-in-difference estimation showed modest impact on condom
use. However, the dose-response findings revealed a 7.5% increase in HIV testing per additional year exposed to the
programme, relative to baseline coverage; an increase in awareness ofHIV status
among HIV-positive individuals of 6.6%; a 6.4% increase in HIV-positive
individuals on treatment; and an 8% reduction in the perception of
stigma/discrimination from healthcare personnel. The cost per person not
exposed to an untreated HIV-positive individual was gauged to be US$400.
CONCLUSIONS:
The
study provides evidence of the effectiveness and cost of a CPP along the HIV treatment cascade: access to HIV tests, awareness of HIV status, and antiretroviral therapy initiation.
- 1aCenter for Research on Health SystemsbCenter for Quality Research and Surveys, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, MexicocIndependent consultantdCentro Nacional para la Prevención del VIH y el SIDA, Mexico City, Mexico.*M. Arantxa Colchero and Sergio Bautista-Arredondo share the first authorship to the writing of this article.
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