Setting Priorities for HIV/AIDS Interventions
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Setting Priorities for HIV/AIDS Interventions

A Cost–Benefit Approach

Robert J. Brent

HIV/AIDS is much too complex a phenomenon to be understood only by reference to common sense and ethical codes. This book presents the cost–benefit analysis (CBA) framework in a well-researched and accessible manner to ensure that the most important considerations are recognized and incorporated.
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Chapter 24: Threshold Analysis Practice: The Benefits of Avoiding HIV

Robert J. Brent


As we know, there are many ways to prevent the spread of HIV. It would be useful if we could obtain a broadly applicable, general estimate of the benefits of avoiding an HIV infection, which then can be compared with the costs of a particular intervention. Holtgrave and Qualls (1995) came up with such an estimate, which they argued would help overcome the tendency in the United States in the mid-1990s to use CBA primarily for treatment rather than prevention programs. According to them, the reluctance to use CBA for prevention stemmed from the extra challenges posed by aiming to change sexual behavior that are not present with treatment evaluations. Thus, prevention CBAs involve the thorny issue of trying to measure program-related changes in sexual behavior when people do not like to reveal information about their behavior in this area. As we shall see, the Holtgrave and Qualls study has strong parallels with the method to determine effectiveness presented in the last chapter. We will, however, emphasize more the benefit estimation part of the work. THE THRESHOLD ESTIMATE OF BENEFITS Recall that the fundamental relation for the threshold method involves finding values for elements where benefits (B) equal costs (C): [B/E] × [E] = C So it is clear that the left-hand side of the relation determines the benefits. In which case it follows that a threshold estimate of the benefits can be determined as: B = [B/E] × [E] In this relation, E is the effect. This can be defined in many different...

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