Date of Award

11-3-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Elisa Long

Second Advisor

David Paltiel

Abstract

The Cost-effectiveness of Alternative HIV Intervention Portfolios in South Africa. Robert Stavert and Elisa Long (Sponsored by David Paltiel). Department of Epidemiology and Public Health, Yale University, School of Medicine, New Haven, Ct. A dynamic compartmental model was instantiated with recent epidemiological data from South Africa to compare the effectiveness and cost-effectiveness of different portfolios of interventions to prevent HIV infection over a twenty year time horizon. We hypothesized that portfolios which combined scaling up the delivery of highly active antiretroviral therapies (HAART), increasing availability of HIV screening and counseling, and establishing widespread circumcision campaigns would be the most effective and most cost-effective strategies. Portfolios which utilized widespread circumcision for adult men were found to be the most cost-effective, while portfolios which utilized a combination of interventions were found to be the most effective, in terms of quality adjusted life years (QALYs) gained. These findings highlight the urgency of scaling up access to life-saving antiretroviral treatments, and providing concomitant investments in HIV prevention and testing programs in a generalized HIV epidemic setting such as South Africa.

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