Implementation of the India AIDS Initiative, Avahan,
reduced HIV prevalence at the population-level by preventing more than 100,000
new HIV infections during the first 5 years, according to new findings
published in The Lancet.
Increased intensity of the program was significantly
associated with lower HIV prevalence in Andhra Pradesh (P=.004),
Karnataka (P=.004) and Maharashtra (P=.008) districts.
Conversely, the association was not significant in Tamil Nadu (P=.06),
Manipur (P=.62) and Nagaland (P=.67) districts.
“A well-planned HIV prevention program can be an
economic and effective means to combat HIV, and by targeting the people at
highest risk, a program can benefit the larger population as well,”
Marie Ng, PhD, assistant professor at the University of Hong Kong, told
Infectious Disease News. “On average, the cost per HIV infection
averted was $2,500, making it cost-effective compared to the amount of care
required to treat a patient with AIDS. In recent years, increased funding has
been shifted to HIV treatment, and this study provides support for the idea
that we should also be funding behavioral interventions and other prevention
Marie Ng, PhD
Ng and colleagues assessed the population-level effect
of the first phase of the HIV-prevention initiative from 2003 to 2008 among
clinic attendees aged 15 to 49 years.
Overall, the HIV initiative averted approximately
100,178 new HIV infections (95% CI, 25,897-207,713) during the study period.
“The program targets the high-risk population,
including female sex workers, their partners and clients, injecting drug users,
men who have sex with men and truck drivers,” Ng said. “By targeting
high-risk groups, the program was able to reduce HIV rates in the broader
population. This has big implications for countries facing similar challenges
from HIV. The key will be to understand the specifics of the populations in
each area and to design a program with those specifics in mind.”
In an accompanying editorial, Ties Boerma, MD,
PhD of WHO in Switzerland, and Isabelle de Zoysa, MD MPH, of
Lungarno Guicciardini in Florence, Italy, wrote: “The report by Ng and
colleagues focuses exclusively on the accountability aspect of evaluation, but
not the learning dimension. To learn from evaluation, it is necessary to
unravel the causal pathway and carefully consider the implementation successes
and failures of the main interventions. Pathway analysis is also necessary to
enhance our confidence in the plausibility of the results.” – by
For more information:
- Boerma T. Lancet. 2011;doi:10.1016/S0140-6736(11)61519-5.
- Ng M. Lancet. 2011;doi:10.1016/S0140-6736(11)61390-1.
Disclosure: This research was funded by the Bill & Melinda