Economic Evaluation of Community-Based HIV Prevention Programs in Ontario: Evidence of Effectiveness in Reducing HIV Infections and Health Care Costs

Choi, Stephanie; Holtgrave, David R.; Bacon, Jean; Kennedy, Richard B.; Lush, Joanne; McGee, Frank; Tomlinson, George; Rourke, Sean B.

doi:10.1007/s10461-015-1109-8

Cited by 9 publications

(6 citation statements)

References 49 publications

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“…What this often leads to is a policy rhetoric about community mobilization and peer leadership and the importance of combining behavioral, biomedical, and structural responses, but community and peer-led programs being funded, monitored and managed as standalone instances of generic interventions. There is conflicting evidence as to the cost effectiveness of peer led health promotion ( 23 – 25 ), however often omitted from the analysis is the potential community and policy system roles of peer-led programs. Moreover, cost-effectiveness studies tend to focus on direct effects rather than synergistic effects registered in other parts of the prevention system as a result of the contribution made by peer leadership activities and programs.…”

Section: Introductionmentioning

confidence: 99%

A Systems Thinking Approach to Understanding and Demonstrating the Role of Peer-Led Programs and Leadership in the Response to HIV and Hepatitis C: Findings From the W3 Project

Brown

Reeders

Cogle

et al. 2018

Front. Public Health

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The central role of community and peer-led programs has been a key characteristic of the Australian partnership response to HIV and hepatitis C since the beginning of the epidemics. Despite this, peer-led programs continue to have limited capacity to demonstrate their role and value as part of a multi-sectoral response. What makes one peer-led program a better investment than another? What role does the rest of the sector have in ensuring we gain the most value from these investments? To investigate this, we facilitated interactive systems thinking methods with 10 programs working within communities of people who inject drugs, gay men, sex workers and people living with HIV across Australia. This included articulating program theories in diagram and textual form to help us understand the role of peer-based programs promoting peer leadership within the Australian HIV and hepatitis C responses. Our aim was to develop a framework for monitoring and evaluation that could be applied to peer led programs at different levels and in different contexts. We found that for peer-led programs to fulfill their role, and to navigate the rapid changes occurring in the both epidemics, they need to: demonstrate the credibility of their peer and community insights; continually adapt to changing contexts and policy priorities in tandem with their communities; and maintain influence in both community and policy systems. We developed a framework of four key functions (Engagement, Alignment, Adaptation, and Influence) which peer-based programs need to demonstrate, which form the basis for identifying quality indicators. This article presents a new way of framing and monitoring investments in peer-led programs and peer eadership actions by these programs. If health policy is committed to strengthening the leadership shown by affected communities, then we need to understand, enhance, monitor and value the role of peer-led programs and peer leadership within the overall prevention system. We believe the W3 framework, drawing on systems thinking and modeling, can support funders, policy-makers and programs to achieve this.

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Section: Introductionmentioning

confidence: 99%

A Systems Thinking Approach to Understanding and Demonstrating the Role of Peer-Led Programs and Leadership in the Response to HIV and Hepatitis C: Findings From the W3 Project

Brown

Reeders

Cogle

et al. 2018

Front. Public Health

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“…Therefore, addressing social and structural factors could significantly improve HIV prevention above individually-based biomedical and behavioral factors [17–19]. For instance, a recent economic evaluation of HIV prevention programs in Ontario, Canada found that province-wide community-based interventions that included increasing social support among residents, providing supportive housing, distributing condoms and needles and running anti-stigma campaigns, were associated with preventing 16,1672 new HIV infections, and saved the health care system approximately 6.5 billion dollars over 23 years [20]. …”

Section: Introductionmentioning

confidence: 99%

Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement

2016

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High neighborhood social capital could facilitate earlier diagnosis of HIV and higher rates of linkage and HIV care engagement. Multivariate analysis was used to examine whether social capital (social cohesion, social participation, and collective engagement) in 2004/2006 was associated with lower 5-year average (2007–2011) prevalence of (a) late HIV diagnosis, (b) linked to HIV care, and (c) engaged in HIV care within Philadelphia, PA, United States. Census tracts (N = 332). Higher average neighborhood social participation was associated with higher prevalence of late HIV diagnosis (b = 1.37, se = 0.32, p < 0.001), linked to HIV care (b = 1.13, se = 0.20, p < 0.001) and lower prevalence of engaged in HIV care (b = −1.16, se = 0.30, p < 0.001). Higher collective engagement was associated with lower prevalence of linked to HIV care (b = −0.62, se = 0.32, p < 0.05).The findings of different directions of associations among social capital indicators and HIV-related outcomes underscore the need for more nuanced research on the topic that include longitudinal assessment across key populations.

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“…Community-based HIV prevention interventions aim at supporting individuals at risk through health promotion services within de ned-geographically communities. They provide education, counselling and mass media campaigning to help their members reduce the risks of infection (14). The goal is to create a perception of community ownership where individuals become agents of change.…”

Section: Importance Of Community-based Interventions In Getting To Zero Hiv Infectionsmentioning

confidence: 99%

Advocating for community-based behavioural approaches within the combination HIV prevention framework: A critical literature review

Giuseppe

West

Furlong³

et al. 2022

Preprint

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Efforts within the combination HIV prevention in the UK have not been sufficiently broad enough to address important aspects of behavioural issues to the end of the HIV epidemic, while also neglecting the role of community-level interventions in developing a more sustainable approach. The restricted impact presented in biomedical interventions calls for the redesign of a more comprehensive preventative protocol, where psychosocial and behavioural strategies that target high-risk local communities are more strongly emphasised. A comprehensive review of empirical studies was undertaken to investigate the reliability of community-based HIV prevention practices, which have targeted behavioural change in demographics and contexts similar to those presented in London. Further recommendations were developed and directed at London’s HIV and sexual health leading actors. The findings of this review have reinforced the argument for the need of community-based, culturally relevant programmes alongside and interweaving with biomedical approaches, and not solely biomedical-focused HIV prevention.

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Economic Evaluation of Community-Based HIV Prevention Programs in Ontario: Evidence of Effectiveness in Reducing HIV Infections and Health Care Costs

Cited by 9 publications

References 49 publications

A Systems Thinking Approach to Understanding and Demonstrating the Role of Peer-Led Programs and Leadership in the Response to HIV and Hepatitis C: Findings From the W3 Project

A Systems Thinking Approach to Understanding and Demonstrating the Role of Peer-Led Programs and Leadership in the Response to HIV and Hepatitis C: Findings From the W3 Project

Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement

Advocating for community-based behavioural approaches within the combination HIV prevention framework: A critical literature review

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