Cost-effectiveness of scaling up voluntary counselling and testing in West-Java, Indonesia.

AIM: to evaluate the costs-effectiveness of scaling up community-based VCT in West-Java. METHODS: the Asian epidemic model (AEM) and resource needs model (RNM) were used to calculate incremental costs per HIV infection averted and per disability-adjusted life years saved (DALYs). Locally monitored demographic, epidemiological behavior and cost data were used as model input. RESULTS: scaling up community-based VCT in West-Java will reduce the overall population prevalence by 36% in 2030 and costs US$248 per HIV infection averted and US$9.17 per DALY saved. Cost-effectiveness estimation were most sensitive to the impact of VCT on condom use and to the population size of clients of female sex workers (FSWs), but were overall robust. The total costs for scaling up community-based VCT range between US$1.3 and 3.8 million per year and require the number of VCT integrated clinics at public community health centers to increase from 73 in 2010 to 594 in 2030. CONCLUSION: scaling up community-based VCT seems both an effective and cost-effective intervention. However, in order to prioritize VCT in HIV/AIDS control in West-Java, issues of budget availability and organizational capacity should be addressed.

Economic aspect of HIV/AIDS control and injecting drug use in Indonesia.

The HIV epidemic in Indonesia is among the fastest growing in Asia, and limited funding is available for HIV/AIDS control. This raises a number of important policy questions, about the adequacy of the level of available funding, the appropriateness of its use, and its financial sustainability. This paper puts these questions in context of the present Indonesian health system. The Indonesian health policy response to HIV/AIDS faces a number of challenges. The nature of the Indonesian HIV epidemic (increasing overall prevalence, with different epidemic profiles); the characteristics of the Indonesian health system (decentralized policy making, low and inequitable funding), and the low and highly internationalized funding of HIV/AIDS control (resulting in low service coverage and questions of sustainability) draw out a very specific health environment of HIV/AIDS. Economic analyses in health are instrumental to guide policy makers on the best use of scarce resources, and holds as such also large potential in this context. However, very little information on the costs and effects of HIV/AIDS control in Indonesia is available, and we call for a broader application.