Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis.

<h4>Background</h4>Most HIV prevention for female sex workers (FSWs) focuses on individual behaviour change involving peer educators, condom promotion and the provision of sexual health services. However, there is a growing recognition of the need to address broader societal, contextual...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Anna Vassall, Sudhashree Chandrashekar, Michael Pickles, Tara S Beattie, Govindraj Shetty, Parinita Bhattacharjee, Marie-Claude Boily, Peter Vickerman, Janet Bradley, Michel Alary, Stephen Moses, CHARME India Group, Charlotte Watts
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/cc266ae32ae6459eb768a08b1c77f1ad
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:cc266ae32ae6459eb768a08b1c77f1ad
record_format	dspace
spelling	oai:doaj.org-article:cc266ae32ae6459eb768a08b1c77f1ad2021-11-25T05:55:48ZCommunity mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis.1932-620310.1371/journal.pone.0110562https://doaj.org/article/cc266ae32ae6459eb768a08b1c77f1ad2014-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0110562https://doaj.org/toc/1932-6203<h4>Background</h4>Most HIV prevention for female sex workers (FSWs) focuses on individual behaviour change involving peer educators, condom promotion and the provision of sexual health services. However, there is a growing recognition of the need to address broader societal, contextual and structural factors contributing to FSW risk behaviour. We assess the cost-effectiveness of adding community mobilisation (CM) and empowerment interventions (eg. community mobilisation, community involvement in programme management and services, violence reduction, and addressing legal policies and police practices), to core HIV prevention services delivered as part of Avahan in two districts (Bellary and Belgaum) of Karnataka state, Southern India.<h4>Methods</h4>An ingredients approach was used to estimate economic costs in US$ 2011 from an HIV programme perspective of CM and empowerment interventions over a seven year period (2004-2011). Incremental impact, in terms of HIV infections averted, was estimated using a two-stage process. An 'exposure analysis' explored whether exposure to CM was associated with FSW's empowerment, risk behaviours and HIV/STI prevalence. Pathway analyses were then used to estimate the extent to which behaviour change may be attributable to CM and to inform a dynamic HIV transmission model.<h4>Findings</h4>The incremental costs of CM and empowerment were US$ 307,711 in Belgaum and US$ 592,903 in Bellary over seven years (2004-2011). Over a 7-year period (2004-2011) the mean (standard deviation, sd.) number of HIV infections averted through CM and empowerment is estimated to be 1257 (308) in Belgaum and 2775 (1260) in Bellary. This translates in a mean (sd.) incremental cost per disability adjusted life year (DALY) averted of US$ 14.12 (3.68) in Belgaum and US$ 13.48 (6.80) for Bellary--well below the World Health Organisation recommended willingness to pay threshold for India. When savings from ART are taken into account, investments in CM and empowerment are cost saving.<h4>Conclusions</h4>Our findings suggest that CM and empowerment is, at worst, highly cost-effective and, at best, a cost-saving investment from an HIV programme perspective. CM and empowerment interventions should therefore be considered as core components of HIV prevention programmes for FSWs.Anna VassallSudhashree ChandrashekarMichael PicklesTara S BeattieGovindraj ShettyParinita BhattacharjeeMarie-Claude BoilyPeter VickermanJanet BradleyMichel AlaryStephen MosesCHARME India GroupCharlotte WattsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 10, p e110562 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Anna Vassall Sudhashree Chandrashekar Michael Pickles Tara S Beattie Govindraj Shetty Parinita Bhattacharjee Marie-Claude Boily Peter Vickerman Janet Bradley Michel Alary Stephen Moses CHARME India Group Charlotte Watts Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis.
description	<h4>Background</h4>Most HIV prevention for female sex workers (FSWs) focuses on individual behaviour change involving peer educators, condom promotion and the provision of sexual health services. However, there is a growing recognition of the need to address broader societal, contextual and structural factors contributing to FSW risk behaviour. We assess the cost-effectiveness of adding community mobilisation (CM) and empowerment interventions (eg. community mobilisation, community involvement in programme management and services, violence reduction, and addressing legal policies and police practices), to core HIV prevention services delivered as part of Avahan in two districts (Bellary and Belgaum) of Karnataka state, Southern India.<h4>Methods</h4>An ingredients approach was used to estimate economic costs in US$ 2011 from an HIV programme perspective of CM and empowerment interventions over a seven year period (2004-2011). Incremental impact, in terms of HIV infections averted, was estimated using a two-stage process. An 'exposure analysis' explored whether exposure to CM was associated with FSW's empowerment, risk behaviours and HIV/STI prevalence. Pathway analyses were then used to estimate the extent to which behaviour change may be attributable to CM and to inform a dynamic HIV transmission model.<h4>Findings</h4>The incremental costs of CM and empowerment were US$ 307,711 in Belgaum and US$ 592,903 in Bellary over seven years (2004-2011). Over a 7-year period (2004-2011) the mean (standard deviation, sd.) number of HIV infections averted through CM and empowerment is estimated to be 1257 (308) in Belgaum and 2775 (1260) in Bellary. This translates in a mean (sd.) incremental cost per disability adjusted life year (DALY) averted of US$ 14.12 (3.68) in Belgaum and US$ 13.48 (6.80) for Bellary--well below the World Health Organisation recommended willingness to pay threshold for India. When savings from ART are taken into account, investments in CM and empowerment are cost saving.<h4>Conclusions</h4>Our findings suggest that CM and empowerment is, at worst, highly cost-effective and, at best, a cost-saving investment from an HIV programme perspective. CM and empowerment interventions should therefore be considered as core components of HIV prevention programmes for FSWs.
format	article
author	Anna Vassall Sudhashree Chandrashekar Michael Pickles Tara S Beattie Govindraj Shetty Parinita Bhattacharjee Marie-Claude Boily Peter Vickerman Janet Bradley Michel Alary Stephen Moses CHARME India Group Charlotte Watts
author_facet	Anna Vassall Sudhashree Chandrashekar Michael Pickles Tara S Beattie Govindraj Shetty Parinita Bhattacharjee Marie-Claude Boily Peter Vickerman Janet Bradley Michel Alary Stephen Moses CHARME India Group Charlotte Watts
author_sort	Anna Vassall
title	Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis.
title_short	Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis.
title_full	Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis.
title_fullStr	Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis.
title_full_unstemmed	Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis.
title_sort	community mobilisation and empowerment interventions as part of hiv prevention for female sex workers in southern india: a cost-effectiveness analysis.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/cc266ae32ae6459eb768a08b1c77f1ad
work_keys_str_mv	AT annavassall communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT sudhashreechandrashekar communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT michaelpickles communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT tarasbeattie communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT govindrajshetty communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT parinitabhattacharjee communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT marieclaudeboily communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT petervickerman communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT janetbradley communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT michelalary communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT stephenmoses communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT charmeindiagroup communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis AT charlottewatts communitymobilisationandempowermentinterventionsaspartofhivpreventionforfemalesexworkersinsouthernindiaacosteffectivenessanalysis
_version_	1718414367744065536

Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis.

Ejemplares similares