The HIV epidemic is becoming financially unsustainable. It is therefore essential to assess the effectiveness and cost-effectiveness of different HIV treatment programmes and models so that the existing limited resources can be allocated optimally. Data are gathered periodically to measure the retention of patients on ART after treatment enrolment at the national level, though this data collection is often complicated by patients lost to follow-up. However, little work so far has assessed the performance (effectiveness and cost-effectiveness) of ART programs differing by the kind of providers and subsequently identified the “good” versus “bad” performers. Identifying the determinants of good performance for ART programmes is essential. Decision-makers will then be able to potentially improve ART delivery in countries.
After two decades of setbacks with microbicide trials, recently two studies demonstrated a proof of concept for microbicides for the first time. With now a demonstrated proof of concept, understanding the potential cost-effectiveness of vaginal microbicides within the currently existing set of HIV prevention interventions becomes crucial. As there it not yet a safe and effective microbicide available, the challenge is to evaluate the potential of the microbicide technology for a hypothetical intervention. Results are reported of a recent study that looked at a potential 1-year intervention targeting a population of women in reproductive age in South Africa and estimated the incremental cost-effectiveness over a year of microbicides when distributed in conjunction with condoms.