Cost-effectiveness of environmental-structural communication interventions for HIV prevention in the female sex industry in the Dominican Republic.
Cost-effectiveness of environmental-structural communication interventions for HIV prevention in the female sex industry in the Dominican Republic.
复制标题
多米尼加共和国女性性行业艾滋病毒预防的环境结构沟通干预措施的成本效益。
DOI：
10.1080/10810730600974829
复制
发表时间：
2006
影响因子：
4.4
通讯作者：
Barrington,Clare
中科院分区：
文献类型：
--
作者：
Sweat,Michael;Kerrigan,Deanna;Moreno,Luis;Rosario,Santo;Gomez,Bayardo;Jerez,Hector;Weiss,Ellen;Barrington,Clare
行为改变沟通通常关注个人层面的变量，如知识、感知风险、自我效能和行为。然而，越来越多的证据表明，改变政策环境的结构性干预和旨在改变自然和社会环境的环境干预进一步加强了影响。人们对这种综合干预方案的成本效益知之甚少。在本研究中，我们使用标准成本分析方法来检验在多米尼加共和国性场所进行的两种此类干预措施的增量成本效益。在圣多明各，干预是环境方面的；在普拉塔港（Puerto Plata），这既是环境方面的，也是结构性的（对不遵守干预措施的性场所老板实施金融制裁）。这两个地点的干预措施都包含了更传统的行为改变交流（BCC）项目中的元素（例如，社区动员、同伴教育、教育材料、宣传贴纸）。一个关键目标是审查增加政策管制是否具有成本效益。用于分析的数据收集自对41家性场所的女性性工作者及其男性固定付费伴侣进行干预前后（1年随访）的结构化行为问卷调查；来自艾滋病毒哨点监测的数据，为干预进行的性传播感染筛查结果；以及我们收集的详细成本数据。我们估计了两种干预模式避免的艾滋病毒感染数量，并将这些估计值转换为与不干预相比节省的残疾生命年数。对模型参数进行单向、双向、三方和多变量敏感性分析。我们对未来成本和收益的贴现率分别为0%、3%（基本情况）和6%。据估计，在圣多明各开展的干预措施（社区动员、宣传媒体和人际沟通）使每1万名服务对象避免了64例艾滋病毒感染，并使每个残疾调整生命年（DALY）的成本节省了1186美元。在普拉塔港，增加了一项政策/监管干预措施，结果每1万名服务对象中避免了162例艾滋病毒感染，并使每DALY的成本节省了457美元。成本效益估计与使用的贴现率和性传播感染的基本比率（影响艾滋病毒传播率）最为相关。两种干预模式都产生了具有成本效益的结果；但是，包括政策管制在内的干预产生了更具成本效益的结果。
Behavior change communication often focuses on individual-level variables such as knowledge, perceived risk, self-efficacy, and behavior. A growing body of evidence suggests, however, that structural interventions to change the policy environment and environmental interventions designed to modify the physical and social environment further bolster impact. Little is known about the cost-effectiveness of such comprehensive intervention programs. In this study we use standard cost analysis methods to examine the incremental cost-effectiveness of two such interventions conducted in the Dominican Republic in sex establishments. In Santo Domingo the intervention was environmental; in Puerto Plata it was both environmental and structural (levying financial sanctions on sex establishment owners who failed to follow the intervention). The interventions in both sites included elements found in more conventional behavior change communication (BCC) programs (e.g., community mobilization, peer education, educational materials, promotional stickers). One key aim was to examine whether the addition of policy regulation was cost-effective.Data for the analysis were gleaned from structured behavioral questionnaires administered to female sex workers and their male regular paying partners in 41 sex establishments conducted pre- and postintervention (1 year follow-up); data from HIV sentinel surveillance, STI screening results conducted for the intervention; and detailed cost data we collected. We estimated the number of HIV infections averted from each of the two intervention models and converted these estimates to the number of disability life years saved as compared with no intervention. One-way, two-way, three-way, and multivariate sensitivity analysis were conducted on model parameters. We examine a discount rate of 0%, 3% (base case), and 6% for future costs and benefits.The intervention conducted in Santo Domingo (community mobilization, promotional media, and interpersonal communication) was estimated to avert 64 HIV infections per 10,000 clients reached, and resulted in a cost per disability-adjusted life year (DALY) saved of $1,186. In Puerto Plata a policy/regulatory intervention was added, which resulted in 162 HIV infections averted per 10,000 clients reached, and yielded a cost per DALY saved of $457. Cost-effectiveness estimates were most correlated to the discount rate used and base rates of sexually transmitted infection (which affects the HIV transmission rate).Both intervention models resulted in cost-effective outcomes; however, the intervention that included policy regulation resulted in a substantially more cost-effective outcome.