interventions.1 Nevertheless, the Committee believes that decisions regarding the allocation of public HIV prevention funds represent the single most important set of HIV prevention decisions made. Further, the Committee’s analysis indicates that a clear, consistently applied strategy of investing prevention funds in interventions that achieve the greatest potential reduction in new HIV infections could increase significantly the number of HIV infections prevented, even within current funding levels. Under this strategy, prevention funds would be allocated to the groups at highest risk and to the interventions that produce the biggest payoff for each dollar invested.

Today, very few policy makers or program administrators recognize either the enormous variation that exists in the cost-effectiveness of different types of programs or the importance of this variation in the overall impact of HIV prevention programs on the epidemic. Economic evaluation has emerged in recent years as an important tool for assisting in health policy decisions, and is increasingly being applied in the HIV prevention field (Holtgrave, 1998). Several major efforts have now examined the role of economic evaluation in public health policy decisions and have addressed methodological issues in conducting these evaluations (Phillips et al., 1998). For instance, the CDC has developed a practical guide to economic evaluation and decision analysis in public health policy decisions (Teutsch and Haddix, 1994; Haddix et al., 1996). The Panel on Cost-Effectiveness in Health and Medicine, convened by the U.S. Public Health Service in 1993, also has provided suggestions for improving the quality and comparability of cost-effectiveness analyses in health care decisions (Gold et al., 1996). In addition, collaborators from the CDC, local governments, academia, industry, and the Task Force on Community Preventive Services have established guidelines for systematic reviews of economic evaluations in community prevention (Carande-Kulis et al., 2000) and are currently examining the cost-effectiveness of HIV prevention interventions.

Still, it is unrealistic to expect that all federal prevention funds will be redirected to interventions that are shown to be the most cost-effective in


Throughout this chapter, the Committee uses the terms “HIV prevention programs,” “HIV prevention interventions,” or “HIV prevention activities” to refer to publicly sponsored actions intended to prevent new HIV infections. Sometimes the Committee discusses specific interventions (such as needle exchange or HIV counseling and testing), while at other times, the Committee discusses a portfolio of activities (such as interventions addressing the needs of injection drug users or men who have sex with men). On occasion, the Committee alludes to federal agency programmatic categories (such as health education and risk reduction efforts sponsored by the CDC). The specific meaning of terms like program, intervention, or activity in any instance will be clear from the context.

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