AEGiS-13IAC: Cost-effectiveness of the female condom in preventing HIV and STDs in commercial sex workers in Rural South Africa.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Cost-effectiveness of the female condom in preventing HIV and STDs in commercial sex workers in Rural South Africa.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrC131)

Marseille E, Kahn JG, Billinghurst K, Saba J
E. Marseille, Health Strategies International, 2 Madrone Place, Orinda, CA 94563, United States, Tel.: +1 925 254 5379, Fax: +1 800 683 3442, E-mail: emarseille@home.com

BACKGROUND: Though apparently as effective as male condoms (MCs) , female condoms (FCs) are more expensive. Under what circumstances, if any, can this additional cost be justified? We assessed the cost-effectiveness of the FC in preventing HIV infection and other STDs among commercial sex workers (CSWs), and their clients in the Mpumulanga Province of South Africa.

METHODS: Current MC use was compared with expected condom use (MC + FC) in a one-year program of FC provision to 1,000 CSWs with an average of 25 clients per year. A simulation model calculated health and public sector cost outcomes assuming five years of HIV infectivity, one month of syphilis and gonorrhea infectivity, and FC use in 12% of episodes of vaginal intercourse. Recurring infections and interactions between STDs and HIV were modeled. The simulation was extended to non-CSWs with as few as ten casual partners per year. We conducted multiple sensitivity analyses.

RESULTS: The intervention is estimated to avert 5.9 HIV, 38 syphilis, and 33 gonorrhea cases while saving the public sector health payer $9,116. Univariate sensitivity analyses indicate that the finding of cost savings or cost-effectiveness is robust across a wide range of values for key inputs. The program generates net savings of $2,216 if per-episode FC efficacy is only 80% rather than the 95% base case estimate; savings of $5,365 if HIV prevalence in CSWs is 25% rather than 50%; and savings of $8,930 if each CSW has an average of 10 clients per year rather than 25. If only 25% of episodes of FC use result in supplemental protection rather than 75% as assumed in the base case, the program would save $645 while averting 2.0 cases of HIV. A program focusing on non-CSWs with only ten casual partners would save $6,484.

CONCLUSION: A well-designed female condom program oriented to CSWs and other women with casual partners is likely to be highly cost-effective and can save public sector health funds in rural South Africa.

Keywords: AEGIS, Condoms, Female, Prostitution, HIV, HIV Infections, Condoms, HIV Seropositivity, Cost-Benefit Analysis, Prevalence, Syphilis, Gonorrhea, South Africa, Human, Female, Male, economics
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MoOrC131