Cost-Effectiveness of Voluntary HIV Counseling and Testing in Reducing Sexual Transmission of HIV-1 in Kenya and Tanzania [Sweat M, et al. Lancet 2000; 356: 113]: The authors performed an analysis of the cost-effectiveness of voluntary counseling and testing in Kenya and Tanzania. The results are summarized in the table below:

Cost-effectiveness of voluntary HIV counseling and testing in Kenya and Tanzania
	Kenya	Tanzania
No. HIV infection averted	1104/yr.	895/yr.
Cost/HIV infection averted	$249	$346
Cost/disability-adjusted life Year saved	$12.77	17.78

Comment: The discussion notes that public health intervention in less-developed countries is recommended if the cost per disability-adjusted life year saved is $50 or less. Prior studies have shown that improved STD services would cost about $10/DALY [Lancet 1997; 350: 1805], and nevirapine to prevent perinatal HIV transmission would cost $5.25 -- $10.51 per DALY [Lancet 1999; 354: 803]. All of these compare favorably with programs for immunization, treatment of acute respiratory infections, school health programs, and short-course tuberculosis treatment, which all fall under the $50 threshold [World Bank. World Development Report: Investing in Health. New York: Oxford University Press, 1993]. The authors of the study note in the discussion that they also assessed the willingness of clients to pay for the services, concluding that they would pay an average of $1.64 in Kenya and $5.11 in Tanzania. When the study was completed, the sites continued to offer the service following a fee schedule based on these results, but the use of service declined significantly. They subsequently decreased the fees to $.50 in Kenya and $1 in Tanzania, and usage increased substantially. These data are highly relevant to the devlopment of strategies for dealing more effectively with HIV infection in Africa. posted 7/19/2000