Costs of HIV Prevention among Out-of-Treatment Drug-Using Women: Results of a Randomized Controlled Trial

Abstract

Objectives. We developed a micro-costing methodology to estimate the real resource costs consumed by delivery of the National Institute on Drug Abuse (NIDA) Cooperative Agreement Standard Intervention (SI) for human immunodeficiency virus (HIV) prevention, plus two enhanced modules, in a three-arm randomized controlled trial (RCT) among drug-using women. To our knowledge, this is the first micro-costing study of the SI and enhanced modules and the first of its kind targeting drug-using women. Methods. We conducted a micro-costing study alongside a three-arm RCT to estimate costs of ( 1) the modified NIDA SI; ( 2) the SI and a well woman exam (SI+WWE); and ( 3) the SI, WWE, and four educational sessions (SI+WWE+4ES) to prevent HIV and sexually transmitted diseases in at-risk, drug-using women in St. Louis, Missouri. Results. The cost of the SI that all 501 participants received was approximately $227 per person. The additional costs for the WWE and 4ES were approximately $145 and $942 per person, respectively. Total program costs for the SI ( n=501) were $113,869; additional costs for the SI+WWE ( n=342) were $49,403 and for the SI+WWE+4ES ( n=170) were $160,189. The main cost component for the SI (64% of total costs) was testing costs, whereas building and facilities costs were the main cost component for the SI+WWE+4ES (75% of total costs). Conclusions. This study provides accurate estimates of the real costs for standard and enhanced HIV interventions for policy makers seeking to implement targeted HIV-prevention programs with scarce resources.