Search

summarizes the methods and key finding of a recent appraisal of the economics of the HIVNET 012 regimen in sub-Saharan Africa.3

There is wide agreement that an effective response to the global HIV epidemic requires very substantial resources. This consensus has been partially translated into increasing contributions to combat the epidemic (UNAIDS 2004). The need to spend this money efficiently can hardly be overstated: the lives of millions depend upon how effectively available funds are allocated. Available studies on the cost and cost-effectiveness of HIV prevention programs in developing countries are very limited in number, as well as in the range of prevention strategies and geographic settings examined (Marseille, Hofmann, and Kahn 2002). “Prevent AIDS: Network for Cost-Effectiveness Analysis” (PANCEA), is a three-year, five-country study funded by the U.S. National Institutes of Health. It has the purpose of providing essential information and analysis for an improved allocation of HIV prevention funds in developing countries. The study includes five countries: India, Mexico, Russia, South Africa, and Uganda. This article reviews PANCEA's data collection methods. Our purpose is two-fold. First, we aim to explicate the methods and data sources used in PANCEA. Second, we want to give other health services researchers sufficient information to judge the potential suitability of adapting PANCEA's approach to their own efforts. Further details on the project and key documents (e.g., instruments) can be found in the online-only Appendix to this article available at http://www.blackwell-synergy.com, at the PANCEA link at http://hivinsite.ucsf.edu/InSite?page=pancea, and from the authors. The remainder of the paper addresses PANCEA's conceptual approach, data collection tools, data collection process, challenges and limitations, early findings, and applications for other health program assessments.

Each year more than 350,000 babies acquire HIV infection from their mother, mainly in Africa. As sadly constant as this fact is, the policy environment around crafting an effective response has changed rapidly and unpredictably. Sequential advances in antiretroviral therapy, preserving effectiveness with far more practical regimens, have repeatedly upped the ante for action, and have also transformed policy issues. This paper relates a modeling story-something of a saga in its meandering course-closely intertwined with evolving policy. Our models have achieved a modicum of success. They have framed several policy discussions and have at least once led directly to an important policy development, as we discuss below. What made that possible? We've identified four elements: solid modeling, which establishes credibility; connected and savvy collaborators, who permit us to reach key decisionmakers (both logistically and in the sense of gaining their serious interest); our policy orientation, which has kept the models practical; and quick adaptations of the model, allowing our participation in fast-moving policy developments. Our models portray the risk of mother-to-child HIV transmission during pregnancy, delivery, and breast-feeding. They also portray the reduction in risk associated with the use of antiretroviral therapy (typically a 40 to 60 percent reduction), and with use of formula feeding instead of breast-feeding. Finally, the models estimate the costs of HIV testing, intervention, and HIV disease in children-in order to estimate the net Costs per HIV infection averted and per Disability Adjusted Life Year (DALY) gained.