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An Analysis of Optimal Resource Allocation for Prevention of Infection with Human Immunodeficiency Virus (HIV) in Injection Drug Users and Non-Users

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  • Anke Richter
  • Margaret L. Brandeau
  • Douglas K. Owens

Abstract

Millions of dollars are spent annually to prevent infection with human immunodeficiency virus (HIV) without a thorough understanding of the most effective way to allocate these resources. The authors' objective was to determme the allocation of new resources among prevention programs targeted to a population of injection drug users (IDUs) and a population of non-injection drug users (non-IDUs) that would minimize the total number of incident cases of HIV infection over a given time horizon. They developed a dynamic model of HIV transmission in IDUs and non-IDUs and estimated the rela tionship between prevention program expenditures and reductions in HIV transmission. They evaluated three prevention programs: HIV testing with routine counseling, HIV testing with intensive counseling, and HIV testing and counseling linked to methadone maintenance programs. They modeled a low-risk IDU population (5% HIV prevalence) and a moderate-risk IDU population (10% HIV prevalence). For different available budgets, they determined the allocation of resources among the prevention programs and populations that would minimize the number of new cases of HIV infection over a five-year period, as well as the incremental value of additional prevention funds. The study framework provides a quantitative, systematic approach to funding programs to prevent HIV infection that accounts for HIV transmission dynamics, population size, and the costs and effectiveness of the interventions in reducing HIV transmission. The approach is general and can be used to evaluate a broader group of prevention pro grams and risk populations. This framework thus could enable policy makers and cli nicians to identify a portfolio of programs that provide, collectively, the most benefit for a given budget. Key words: HIV; AIDS; HIV-1; resource allocation; prevention; cost- benefit analysis. (Med Decis Making 1999;19:167-179)

Suggested Citation

  • Anke Richter & Margaret L. Brandeau & Douglas K. Owens, 1999. "An Analysis of Optimal Resource Allocation for Prevention of Infection with Human Immunodeficiency Virus (HIV) in Injection Drug Users and Non-Users," Medical Decision Making, , vol. 19(2), pages 167-179, April.
    • Handle: RePEc:sae:medema:v:19:y:1999:i:2:p:167-179
    DOI: 10.1177/0272989X9901900207
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    References listed on IDEAS

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    1. Charles Reveller & Walter Lynn & Floyd Feldmann, 1969. "An Optimization Model of Tuberculosis Epidemiology," Management Science, INFORMS, vol. 16(4), pages 190-211, December.
    2. Douglas K. Owens & Margaret L. Brandeau & Carol H. Sox, 1998. "Effect of Relapse to High-Risk Behavior on the Costs and Benefits of a Program to Screen Women for Human Immunodeficiency Virus," Interfaces, INFORMS, vol. 28(3), pages 52-74, June.
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    Cited by:

    1. Sarang Deo & Sameer Mehta & Charles J. Corbett, 2022. "Optimal Scale‐Up of HIV Treatment Programs in Resource‐Limited Settings Under Supply Uncertainty," Production and Operations Management, Production and Operations Management Society, vol. 31(3), pages 883-905, March.
    2. Elisa F. Long & Eike Nohdurft & Stefan Spinler, 2018. "Spatial Resource Allocation for Emerging Epidemics: A Comparison of Greedy, Myopic, and Dynamic Policies," Manufacturing & Service Operations Management, INFORMS, vol. 20(2), pages 181-198, May.
    3. Wilson, Amy R. & Kahn, James G., 2003. "Preventing HIV in injection drug users: exploring the tradeoffs between interventions," Socio-Economic Planning Sciences, Elsevier, vol. 37(4), pages 269-288, December.
    4. Sabina Alistar & Elisa Long & Margaret Brandeau & Eduard Beck, 2014. "HIV epidemic control—a model for optimal allocation of prevention and treatment resources," Health Care Management Science, Springer, vol. 17(2), pages 162-181, June.
    5. Zoë K. Harris, 2006. "Efficient allocation of resources to prevent HIV infection among injection drug users: the Prevention Point Philadelphia (PPP) needle exchange program," Health Economics, John Wiley & Sons, Ltd., vol. 15(2), pages 147-158, February.

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