Efficient and equitable HIV prevention: A case study of male circumcision in South Africa
Open Access
- 1 January 2013
- journal article
- research article
- Published by Springer Science and Business Media LLC in Cost Effectiveness and Resource Allocation
- Vol. 11 (1), 1-7
- https://doi.org/10.1186/1478-7547-11-1
Abstract
We determine efficient, equitable and mixed efficient-equitable allocations of a male circumcision (MC) intervention reducing female to male HIV transmission in South Africa (SA), as a case study of an efficiency-equity framework for resource allocation in HIV prevention. We present a mathematical model developed with epidemiological and cost data from the nine provinces of SA. The hypothetical one-year-long MC intervention with a budget of US$ 10 million targeted adult men 15–49 years of age in SA. The intervention was evaluated according to two criteria: an efficiency criterion, which focused on maximizing the number of HIV infections averted by the intervention, and an equity criterion (defined geographically), which focused on maximizing the chance that each male adult individual had access to the intervention regardless of his province. A purely efficient intervention would prevent 4,008 HIV infections over a year. In the meantime, a purely equitable intervention would avert 3,198 infections, which represents a 20% reduction in infection outcome as compared to the purely efficient scenario. A half efficient-half equitable scenario would prevent 3,749 infections, that is, a 6% reduction in infection outcome as compared to the purely efficient scenario. This paper provides a framework for resource allocation in the health sector which incorporates a simple equity metric in addition to efficiency. In the specific context of SA with a MC intervention for the prevention of HIV, incorporation of geographical equity only slightly reduces the overall efficiency of the intervention.Keywords
This publication has 40 references indexed in Scilit:
- Reassessing HIV PreventionScience, 2008
- S4HARA: System for HIV/AIDS resource allocationCost Effectiveness and Resource Allocation, 2008
- Circumcision for HIV Prevention: Failure to Fully Account for Behavioral Risk CompensationPLoS Medicine, 2007
- Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African SettingPLoS Medicine, 2006
- Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa: A ReviewAIDS and Behavior, 2006
- Predicting the epidemiological impact of antiretroviral allocation strategies in KwaZulu-Natal: The effect of the urban–rural divideProceedings of the National Academy of Sciences of the United States of America, 2006
- The Potential Impact of Male Circumcision on HIV in Sub-Saharan AfricaPLoS Medicine, 2006
- Uganda's HIV Prevention Success: The Role of Sexual Behavior Change and the National ResponseAIDS and Behavior, 2006
- Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 TrialPLoS Medicine, 2005
- Designing Equitable Antiretroviral Allocation Strategies in Resource-Constrained CountriesPLoS Medicine, 2005