Highly Active Antiretroviral Therapy (HAART) has proven to be a cost-effective solution to increasing the quality of life of HIV-infected individuals living in high-income countries. In southern African countries, however, there is debate regarding the economic feasibility of initiating antiretroviral therapy programs sponsored by the public sector.

Researchers at HAI are conducting studies in Botswana and Senegal in an effort to inform policy decisions regarding the costs and cost-effectiveness of HIV prevention and care interventions in these countries.

Cost-Effectiveness of HAART for HIV and AIDS in Botswana
The Government of Botswana is preparing for the country-wide provision of HAART, and faces important decisions regarding the most efficient use of available resources in scaling up HAART to a national level. This study aims to help the government make decisions regarding the national HAART program in Botswana, and to advise on the best approaches to the delivery of HAART in other countries within the region.

This study uses mathematical modeling techniques to evaluate a number of areas related to the national HAART program in Botswana. Researchers are comparing the cost-effectiveness of HAART to the cost of care and prevention services without the use of HAART, the cost-effectiveness of commencing HAART at various stages of HIV, and the costs of antiretroviral therapy using different models of care delivery, such as the self-administration of treatment.

Cost-Effectiveness of HIV Prevention and Care in Senegal
The Government of Senegal is currently considering ways to scale up HIV prevention and care to semi-urban and rural areas in which health services are insufficient. Interventions under consideration include voluntary HIV counseling and testing services, programs for the prevention of mother-to-child transmission, opportunistic infection treatment and prophylaxis, and highly active antiretroviral therapy.

The study plans to use mathematical modeling techniques to estimate the cost effectiveness of these HIV interventions as compared with the standard of care in these sites. Researchers will also determine the lifetime costs per person associated with comprehensive HIV prevention and care, and estimate the long-term resources required for sustaining these interventions at a national level.

For more information about these studies, contact Marionette Holmes, at 617-432-4400 (phone), 617-432-4545 (fax) or mholmes@hsph.harvard.edu.