Study finds large savings from investment in community-based HIV prevention programs

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Chronic illness can have a huge impact on the economies of cities, regions and countries. Researchers in the U.S. have estimated that the lifetime cost of care for HIV can range from about $250,000 to $400,000 per person. One way to reduce healthcare costs is to invest in disease prevention programs delivered through community-based organizations.

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For many years, researchers at the U.S. Centers for Disease Control and Prevention (CDC) have been investigating the link between investment in community-based HIV prevention programs and outcomes—new HIV infections. Such research is not easy because the effect of investment in prevention may not become apparent for several years. However, the CDC has developed expertise in evaluating the economic impact of HIV prevention efforts.

Researchers working with the CDC have found that investment in community-based HIV prevention programs have had at least the following effects:

  • a reduction in new cases of HIV, specifically preventing more than 351,000 infections between 1991 and 2006
  • saving the healthcare system $130 billion ($US)

Focus on Ontario

In the province of Ontario, health authorities have been reliant on community-based agencies to engage in the work of HIV prevention, including awareness and education campaigns for populations at risk.

A team of researchers from the University of Toronto, Johns Hopkins University (Baltimore, Maryland), the Ontario Ministry of Health and Long-Term Care, the Ontario HIV Treatment Network (OHTN) and the Ontario AIDS Network recently completed their economic impact analysis of community-based HIV prevention programs funded between 1987 and 2011. Their analysis found that HIV prevention investments averted thousands of new infections and saved nearly $7 billion ($CAD) in costs to the healthcare system.

What’s more, the researchers found that investments in community-based HIV prevention programs made between 2005 and 2011 resulted in large savings measured another way. For each dollar invested in such prevention programs and services, five dollars in future costs were saved because of reduced HIV infections.

In context

The findings in Ontario are broadly similar to results of evaluations of community-based HIV prevention programs in Australia and the U.S. As Ontario has a single payer system for health care (the government), savings that occur in HIV allow investment in other parts of the healthcare system.

The research team made the following statement about the results:

“Our results from the financial return on investment (ROI) ratio for community-based HIV programs were comparable to findings of ROI ratios in mental health promotion programs and other strategies, which ranged from one dollar to $25. Our ROI estimate was conservative because we only included savings in direct healthcare costs as opposed to the broader health and social benefits of averted HIV infections.”

Looking ahead

Vaccines have played an essential role in helping to protect entire regions and countries from viral infections. Also, mass vaccination campaigns play an important role in eradicating these diseases. Such campaigns have been so effective that diseases such as smallpox no longer occur worldwide and polio no longer occurs in most countries.

However, despite at least 30 years of research, the development of an effective HIV vaccine has been elusive. There is also no cure in sight. These facts, combined with a resurgence in syphilis and HIV among some sexually active men in high-income countries, mean that the HIV epidemic will not recede anytime soon. Therefore, continued investment in prevention programs and services in community-based organizations are necessary to contain the spread of HIV and common sexually transmitted infections.

—Sean R. Hosein

REFERENCES:

  1. Choi SKY, Holtgrave DR, Bacon J, et al. Economic evaluation of community-based HIV prevention programs in Ontario: evidence of effectiveness in reducing HIV infections and health care costs. AIDS and Behavior. 2015; in press.
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