Abstract
Objective
Non-governmental organisations (NGOs) in Ukraine have provided HIV testing, treatment, and condom distribution for men who have sex with men (MSM). HIV prevalence among MSM in Ukraine is 5.6%. We estimated the impact and cost-effectiveness of MSM-targeted NGO activities in Ukraine.
Design
A mathematical model of HIV transmission among MSM was calibrated to data from Ukraine (2011-2018).
Methods
The model, designed before the 2022 Russian invasion of Ukraine, evaluated the impact of 2018 status quo (SQ) coverage levels of 28% of MSM being NGO clients over 2016-2020 and 2021-2030 compared to no NGO activities over these time periods. Impact was measured in HIV incidence and infections averted. We compared the costs and disability adjusted life years [DALYs] for the SQ and a
counterfactual scenario (no NGOs 2016-2020, but with NGOs thereafter) until 2030 to estimate the mean incremental cost-effectiveness ratio (ICER, cost per DALY averted).
Results
Without NGO activity over 2016-2020, the HIV incidence in 2021 would have been 44% (95%CrI: 36%-59%) higher than with SQ levels of NGO activity, with 25% (21-30%) more incident infections occurring over 2016-2020. Continuing with SQ NGO coverage levels will decrease HIV incidence by 41% over 2021-2030, whereas it will increase by 79% (60-120%) with no NGOs over this period and
37% (30-51%) more HIV infections will occur. Compared to if NGO activities had ceased over 2016-2020 (but continued thereafter), the SQ scenario averts 14,918 DALYs over 2016-2030 with a mean ICER of US$600.15 per DALY averted.
Conclusions
MSM-targeted NGOs in Ukraine have prevented considerable HIV infections and are highly cost-effective compared with a willingness-to-pay threshold of 50% of Ukraine’s 2018 GDP (US$1,548).
Non-governmental organisations (NGOs) in Ukraine have provided HIV testing, treatment, and condom distribution for men who have sex with men (MSM). HIV prevalence among MSM in Ukraine is 5.6%. We estimated the impact and cost-effectiveness of MSM-targeted NGO activities in Ukraine.
Design
A mathematical model of HIV transmission among MSM was calibrated to data from Ukraine (2011-2018).
Methods
The model, designed before the 2022 Russian invasion of Ukraine, evaluated the impact of 2018 status quo (SQ) coverage levels of 28% of MSM being NGO clients over 2016-2020 and 2021-2030 compared to no NGO activities over these time periods. Impact was measured in HIV incidence and infections averted. We compared the costs and disability adjusted life years [DALYs] for the SQ and a
counterfactual scenario (no NGOs 2016-2020, but with NGOs thereafter) until 2030 to estimate the mean incremental cost-effectiveness ratio (ICER, cost per DALY averted).
Results
Without NGO activity over 2016-2020, the HIV incidence in 2021 would have been 44% (95%CrI: 36%-59%) higher than with SQ levels of NGO activity, with 25% (21-30%) more incident infections occurring over 2016-2020. Continuing with SQ NGO coverage levels will decrease HIV incidence by 41% over 2021-2030, whereas it will increase by 79% (60-120%) with no NGOs over this period and
37% (30-51%) more HIV infections will occur. Compared to if NGO activities had ceased over 2016-2020 (but continued thereafter), the SQ scenario averts 14,918 DALYs over 2016-2030 with a mean ICER of US$600.15 per DALY averted.
Conclusions
MSM-targeted NGOs in Ukraine have prevented considerable HIV infections and are highly cost-effective compared with a willingness-to-pay threshold of 50% of Ukraine’s 2018 GDP (US$1,548).
| Original language | English |
|---|---|
| Pages (from-to) | 2025-2034 |
| Number of pages | 10 |
| Journal | AIDS |
| Volume | 36 |
| Issue number | 14 |
| DOIs | |
| Publication status | Published - 15 Nov 2022 |
Research Groups and Themes
- HEHP@Bristol
Keywords
- Harm reduction
- NGO
- MSM
- HIV
- modelling
- Eastern Europe
Access to Document
- Full-text PDF (author accepted manuscript)
This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Lippincott, Williams & Wilkins at https://journals.lww.com/aidsonline/Fulltext/2022/11150/Impact_and_cost_effectiveness_of_non_governmental.14.aspx. Please refer to any applicable terms of use of the publisher.