1. 10/18/2011
Estimating the Cost of HIV Prevention
Interventions with Demonstrated
Effectiveness in Reducing Risky
Behaviors
Ram K. Shrestha, PhD; Stephanie L. Sansom, PhD
Paul G. Farnham, PhD; Arielle Lasry, PhD
Prevention Modeling and Economics Team
2011 National HIV Prevention Conference
August 14-17, 2011, Atlanta, GA
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention
Background
DHAP reviews and analyzes the literature on
behavioral interventions intended to reduce HIV-related
risk behaviors1
Interventions included individual-level (ILI), group-level
(GLI) interventions
Based on the relative strength of the scientific evidence
of efficacy, DHAP recommends these interventions for
adoption in various settings and populations
1. Centers for Disease Control and Prevention. 2009 Compendium of Evidence-Based HIV Prevention Interventions, Division
of HIV/AIDS Prevention, Atlanta, GA. (http://www.cdc.gov/hiv/topics/research/prs/evidence-based-interventions.htm,
accessed: 6/30/2011)
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Background
Health care planners and providers receive training
and technical assistance from DHAP to implement
these interventions
They need information on the implementation cost of
the interventions, but cost data are not readily
available
Resource utilization information provided in the
efficacy literature can be used to estimate the
intervention costs
Objectives
Estimate the cost of evidence-based behavioral
interventions based on published literature
Compare the cost of individual- and group-level
interventions
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Methods
Developed a simple method to estimate the total cost
(variable and fixed) of recommended behavioral
interventions
Variable costs:
Hours of labor required to deliver each intervention, as
reported in the efficacy of the interventions, and additional
information provided by the authors
Wage and fringe benefits of medical and public health social
workers based on 2009 U.S. BLS data2
2. Average wage and fringe benefits of medical and public health social workers $28.94 (National Occupational Employment
and Wage Estimates, Bureau of Labor Statistics, 2009)
Methods
Fixed costs:
Based on the proportion of total cost reported in 4 published
studies of similar HIV prevention interventions not included in
our cost analysis
Included the cost of program operation and management, such
as administrative staff time, training, travel, facility overhead,
and office supplies
Represented 80% of the total intervention cost
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Selection of Interventions
We selected 2 interventions each from DHAP-
recommended ILIs and GLIs to illustrate our cost analysis
approach
Selection based on the greatest number of health care
providers receiving the training to implement the
interventions
Selected Interventions
Individual-level interventions:
RESPECT-brief counseling intervention
HIV-negative, heterosexual, STD clinic patients
2 interactive individual counseling sessions, delivered by a
trained HIV/STD counselor
462 providers completed training
MIP-Modelo de Intervecion Psicomedica
HIV-negative, Hispanic drug injectors
6 one-on-one counseling sessions, delivered by a registered
nurse and a case manager
31 providers completed training
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Selected Interventions
Group-level interventions:
WILLOW-Women Involved in Life Learning from Other
Women
HIV-positive, sexually active female clinic patients
4, 4-hour sessions over 4 weeks, delivered by 2 facilitators
Small groups of 8-10 women per group
46 providers completed training
SIHLE-Sistering, Informing, Healing, Living, and
Empowering
HIV-negative, sexually experienced African American girls
4, 4-hour sessions over 4 weeks, delivered by 3 facilitators
Small groups of 10-12 girls per group
30 providers completed training
Results
Individual-Level Interventions (ILI)
Intervention
RESPECT MIP
Number of individual sessions 2 6
Length of session, hr 0.33 1.00
Facilitators’ time per participant, hr 0.67 6.00
Intervention participants 1,447 285
Total intervention cost, $ $139,578 $247,420
Cost per participant, $ $96 $868
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Results
Group-level interventions (GLI)
Intervention
WILLOW SIHLE
Number of groups 21 23
Sessions per group 4.00 4.00
Length of group session, hr 4.00 4.00
Facilitators’ time per group, hr 32.00 48.00
Participants per group session 9 11
Intervention participants 192 251
Total intervention cost, $ $215,125 $185,475
Cost per participant, $ $514 $631
Results
Intervention costs varied within and across ILIs and GLIs
In ILIs, cost substantially lower in RESPECT-brief counseling
intervention ($96 v. $868/participant)
Shorter and fewer individual counseling sessions
In GLI, costs similar in both interventions ($514 v.
$631/participant)
Same number and length of group sessions
Simplicity of the intervention and lower cost might have led to
higher demand for RESPECT-brief counseling intervention
(462 providers trained)
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Limitations
Estimated costs based on limited information provided in the
literature
We assumed fixed costs comprised the same proportion of
total costs despite the number of clients served, thus did not
allow for economies of scale
Conclusions
Intervention costs depend on the intensity of the intervention,
in terms of number and length of sessions
Estimated costs are based on limited information provided in
the literature on variable and fixed costs
Cost estimates assist HIV prevention planners and providers
who implement the interventions
Future research should compare the costs with intervention
effectiveness
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Thank You.
Questions/Comments?
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of
the Centers for Disease Control and Prevention.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention
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