Cost-Effectiveness of HIV Prevention Strategies: A Systematic Review of Economic Evaluations.

Abstract

Background: HIV/AIDS continues to pose a significant global health challenge, especially in low- and middle-income countries. Economic evaluations are essential to identify cost-effective prevention strategies and allocate limited healthcare resources efficiently.

Objective: This systematic review aimed to assess the cost-effectiveness of HIV prevention interventions across various populations and settings, and to evaluate the methodological quality of the included studies.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and Scopus for English-language studies published between January 2003 and November 2023. The PRISMA guidelines were followed for the review process. The quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

Results: Thirteen studies met the inclusion criteria, exhibiting diverse methodologies, target populations, and healthcare perspectives. The majority of studies reported that primary prevention methods-such as prenatal screening, harm reduction programs for drug users, and pre-exposure prophylaxis (PrEP) for high-risk groups-were more cost-effective than secondary or tertiary interventions. Study populations included pregnant women (38.4%), injection drug users (23.1%), men who have sex with men (23.1%), and general populations (15.4%). Overall, most studies demonstrated medium to high methodological quality.

Conclusion: Primary prevention strategies for HIV are generally cost-effective, especially when tailored to specific high-risk populations. However, more robust, context-specific evaluations are needed to support policy-making across diverse healthcare systems. Decision-makers should prioritize investment in early detection and preventive programs to optimize outcomes and resource use.