TY - JOUR
T1 - The cost and cost-effectiveness of gender-responsive interventions for HIV
T2 - A systematic review
AU - Remme, Michelle
AU - Siapka, Mariana
AU - Vassall, Anna
AU - Heise, Lori
AU - Jacobi, Jantine
AU - Ahumada, Claudia
AU - Gay, Jill
AU - Watts, Charlotte
PY - 2014/11/4
Y1 - 2014/11/4
N2 - Introduction: Harmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective.Methods: Effective intervention models were identified from an existing evidence review (''what works for women''). Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects.Results: Our effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and postexposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings.Conclusions: There has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework. Copyright:
AB - Introduction: Harmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective.Methods: Effective intervention models were identified from an existing evidence review (''what works for women''). Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects.Results: Our effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and postexposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings.Conclusions: There has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework. Copyright:
KW - Cost
KW - Cost-effectiveness
KW - Critical enablers
KW - Development synergies
KW - Gender equality
KW - Gender-based violence
KW - HIV/AIDS
KW - Investment approaches
UR - http://www.scopus.com/inward/record.url?scp=84915746315&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84915746315&partnerID=8YFLogxK
U2 - 10.7448/IAS.17.1.19228
DO - 10.7448/IAS.17.1.19228
M3 - Review article
C2 - 25373519
AN - SCOPUS:84915746315
SN - 1758-2652
VL - 17
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
M1 - 19228
ER -