The cost-effectiveness of the WINGS intervention: a program to prevent HIV and sexually transmitted diseases among high-risk urban women.

BACKGROUND: We evaluated the cost-effectiveness of the WINGS project, an intervention to prevent HIV and other sexually transmitted diseases among urban women at high risk for sexual acquisition of HIV. METHODS: We used standard methods of cost-effectiveness analysis. We conducted a retrospective analysis of the intervention's cost and we used a simplified model of HIV transmission to estimate the number of HIV infections averted by the intervention. We calculated cost-effectiveness ratios for the complete intervention and for the condom use skills component of the intervention. RESULTS: Under base case assumptions, the intervention prevented an estimated 0.2195 new cases of HIV at a cost of $215,690 per case of HIV averted. When indirect costs of HIV were excluded from the analysis, the intervention's cost-effectiveness ratios were $357,690 per case of HIV averted and $31,851 per quality-adjusted life year (QALY) saved. Under base case assumptions, the condom use skills component of the intervention prevented an estimated 0.1756 HIV infections and was cost-saving. When indirect HIV costs were excluded, the cost-effectiveness ratios for the condom use skills component of the intervention were $97,404 per case of HIV averted and $8,674 per QALY saved. CONCLUSIONS: The WINGS intervention, particularly the two sessions of the intervention which focussed on condom use skills, could be cost-effective in preventing HIV among women.

Learning from clients: an opportunity for sexually transmitted disease programs.

This article summarizes sexually transmitted disease (STD) knowledge, health care-seeking behaviors, and perceived advantages to seeking care from the perspective of 397 STD clinic clients interviewed between 1997 and 1999 in three northeastern cities. More than half reported a prior STD. Mean days delay in seeking treatment was 10.8. Reasons for delay included lack of knowledge especially about symptoms (44%) and inconvenience, especially clinic hours (46%). Major disadvantages to receiving care centered around embarrassment and stress (24%). Programs need to develop more intensive counseling for repeat clients, offer more flexible hours, address sources of stress inherent in their services, and develop better marketing strategies. Successful behavioral interventions, behavioral training, and creative approaches from the popular literature may be helpful.