A multicountry European study on Succeed: a general quality improvement tool in HIV prevention.

The context-sensitive nature of the European HIV epidemic (e.g. differences in key populations, prevention settings, resource commitments) makes it challenging to monitor and evaluate HIV prevention and sexual health promotion programs. Systematic quality improvement (QI) tools and quality indicators adapted to HIV prevention are not widely known or implemented. The European 'Quality Action' introduced five such tools in 26 countries involving 45 nongovernmental and governmental organizations during 2014-2016. Approximately, half of the organizations used the tool 'Succeed'. This study aims to describe challenges and supportive factors in its use, and answers the research question if Succeed can be applied as a general QI tool despite the high contextuality of the European HIV prevention field. Mixed method research was conducted: data from quantitative pre- and post-training and implementation surveys were triangulated with qualitative data from multiple data sources analysed inductively. In a second analytical step, Chaudoir's evidence-based framework on implementation of innovations (2013) guided the data analysis on five levels: policy, organization, functionality of the tool, results and perceived innovations. Succeed contributed to goal and result orientation, facilitated stakeholders' participation and contributed to organizational development. Succeed was used in similar ways and with similar results across different policy contexts, types of organizations, target groups and interventions. Contributing factors for sustainable implementation were supporting environments, sufficient resources and a strategy for training tool users. Findings strongly support the use of Succeed as a general QI tool to monitor, document, adapt and improve HIV prevention and sexual health promotion work across Europe.

An economic case for providing free access to antiretroviral therapy for HIV-positive people in South Australia.

BACKGROUND: As financial constraints can be a barrier to accessing HIV antiretroviral therapy (ART), we argue for the removal of copayment requirements from HIV medications in South Australia. METHODS: Using a simple mathematical model informed by available behavioural and biological data and reflecting the HIV epidemiology in South Australia, we calculated the expected number of new HIV transmissions caused by persons who are not currently on ART compared with transmissions for people on ART. The extra financial investment required to cover the copayments to prevent an HIV infection was compared with the treatment costs saved due to averting HIV infections. RESULTS: It was estimated that one HIV infection is prevented per year for every 31.4 persons (median, 24.0-42.7 interquartile range (IQR)) who receive treatment. By considering the incremental change in costs and outcomes of a change in program from the current status quo, it would cost the health sector $17860 per infection averted (median, $13651-24287 IQR) if ART is provided as a three-dose, three-drug combination without requirements for user-pay copayments. CONCLUSIONS: The costs of removing copayment fees for ART are less than the costs of treating extra HIV infections that would result under current conditions. Removing the copayment requirement for HIV medication would be cost-effective from a governmental perspective.