The impact and cost-effectiveness of expanding harm reduction activities for injecting drug users in Odessa, Ukraine
Objectives: To estimate the cost-effectiveness of a harm reduction intervention amongst injecting drug users (IDUs) in Odessa, Ukraine. To explore how the cost-effectiveness changes if the intervention were scaled-up to 60%, as recommended by WHO/UNAIDS .
Study Design: Economic provider's costs were estimated. A dynamic mathematical model, fitted to epidemiological data, projected the intervention's impact. The cost per HIV-infection averted for different intervention coverages was estimated.
Results: From September 1999-August 2000, at the current coverage of between 20-38% and an IDU HIV-prevalence of 54%, projections suggest 792 HIV-infections averted, a 22% decrease in IDU HIV-incidence, but a 1% increase in IDU HIV-prevalence. Cost per HIV-infection averted was $97. Scaling up the intervention to reach 60% of IDUs remains cost-effective, and reduces HIV-prevalence by 4% over 5-years.
Conclusion: At the current coverage, the harm reduction intervention in Odessa is cost-effective, but is unlikely to reduce IDU HIV-prevalence in the short-term. To reduce HIV-prevalence more resources are needed to increase coverage.
Sexually Transmitted Diseases (2006) 33 (10 Suppl.) S89-S102 [doi: 10.1097/01.olq.0000221335.80508.fa]