Cost-effectiveness of HIV/AIDS interventions in South Africa.
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Date
2014
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Abstract
Despite some evidence that the effectiveness of HIV/AIDS interventions depends
on the context of their implementation, there is a paucity of evidence on the
cost-effectiveness (CE) of these interventions in South Africa. The objective of
this study is therefore to compare the CE of major HIV/AIDS interventions in
epidemiological and socio-economic contexts in South Africa using a
methodology which takes into account the effect of the interaction between the
context and HIV/AIDS interventions on the costs and effectiveness of such
interventions. In epidemiological contexts, the CE of HIV/AIDS interventions is
compared across a low HIV prevalence context (LPC) and a high HIV prevalence
context (HPC) while in socio-economic contexts the comparison is done across a
rural context and an urban context.
The comparison of the CE of HIV/AIDS interventions requires the follow-up of
patients in HIV/AIDS progression states (non-infected, infected, AIDS, death)
over time. However because this follow-up is costly, the thesis models
hypothetical populations of HIV/AIDS patients in each context, using two types
of models, namely, Markov models and population projection models. These
models simulate and project patients in the above-mentioned HIV/AIDS states
over time and the cost and effectiveness data, systematically collected from
South African literature, are applied to simulated and projected patients.
The study finds that in epidemiological contexts, modelled HIV/AIDS
interventions are generally more cost-effective in a LPC than they are in a HPC.
In socio-economic contexts, the pattern of the CE of modelled HIV/AIDS
interventions across a rural and an urban context is not specific and depends on
the type of intervention. Prevention of mother-to-child transmission (PMTCT) is
more cost-effective in the rural context than it is in the urban context while
highly active antiretroviral treatment for adults and children is more costeffective
in the urban context than it is in the rural context. The study also finds
that the extent of CE varies across HIV/AIDS interventions in any context.
Therefore policy makers should allocate resources in accordance with these CE
variations.
Description
Doctor of Philosophy in Economics. University of KwaZulu-Natal, Westville 2014.
Keywords
HIV infections--South Africa--Prevention--Cost effectiveness., AIDS (Disease)--South Africa--Prevention--Cost effectiveness., Theses--Economics., HIV/AIDS intervention.