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Cost effectiveness of HIV and sexual reproductive health interventions targeting sex workers: a systematic review

机译：艾滋病毒和性生殖健康干预的成本效益为目标性工作者：系统审查

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Sex workers have high incidences of HIV and other sexually transmitted diseases. Although, interventions targeting sex workers have shown to be effective, evidence on which strategies are most cost-effective is limited. This study aims to systematically review evidence on the cost-effectiveness of sexual health interventions for sex workers on a global level. It also evaluates the quality of available evidence and summarizes the drivers of cost effectiveness. A search of published articles until May 2018 was conducted. A search strategy consisted of key words, MeSH terms and other free text terms related to economic evaluation, sex workers and sexual and reproductive health (SRH) was developed to conduct literature search on Medline, Web of Science, Econlit and the NHS Economic Evaluation Database. The quality of reporting the evidence was evaluated using the CHEERS checklist and drivers of cost-effectiveness were reported. Overall, 19 studies met the inclusion criteria. The majority of the studies were based in middle-income countries and only three in low-income settings. Most of the studies were conducted in Asia and only a handful in Sub-Saharan Africa and Latin America. The reviewed studies mainly evaluated the integrated interventions, i.e. interventions consisted a combination of biomedical, structural or behavioural components. All interventions, except for one, were highly cost-effective. The reporting quality of the evidence was relatively good. The strongest drivers of cost-effectiveness, reported in the studies, were HIV prevalence, number of partners per sex worker and commodity costs. Furthermore, interventions integrated into existing health programs were shown to be most cost-effective. This review found that there is limited economic evidence on HIV and SRH interventions targeting sex workers. The available evidence indicates that the majority of the HIV and SRH interventions targeting sex workers are highly cost-effective, however, more effort should be devoted to improving the quality of conducting and reporting cost-effectiveness evidence for these interventions to make them usable in policy making. This review identified potential factors that affect the cost-effectiveness and can provide useful information for policy makers when designing and implementing such interventions.
机译：性工作者的艾滋病毒患者和其他性传播疾病的患者很高。虽然，针对性工作者的干预措施表明有效，有关哪些策略最具成本效益的证据是有利的。本研究旨在系统地审查有关全球性水平的性工作者性健康干预措施的成本效益的证据。它还评估了可用证据的质量，并总结了成本效益的驱动因素。在2018年5月之前搜索已发布的文章。搜索策略包括与经济评估，性工作者和性和生殖健康（SRH）的关键词，网格条款和其他自由文本术语制定，开展文学搜索，科学网站，econlit和NHS经济评估数据库。报告质量使用CHEERS清单评估了证据，并报告了成本效益的驱动因素。总体而言，19项研究达到了纳入标准。大多数研究基于中等收入国家，只有三个低收入环境。大多数研究是在亚洲进行的，只在撒哈拉以南非洲和拉丁美洲进行了少数。审查的研究主要评估了综合干预措施，即干预措施包括生物医学，结构或行为组分的组合。除了一个外，所有干预措施都是高度成本效益。证据的报告质量相对较好。在研究中报道的成本效益最强的驾驶员是艾滋病毒患病率，每个性工作者和商品成本的合作伙伴数量。此外，纳入现有健康计划的干预率被认为是最具成本效益的。该审查发现，艾滋病毒的经济证据有限，艾滋病病毒病毒症和SRH干预措施是针对性工作者的干预措施。可用证据表明，针对性工作者的大多数艾滋病毒和SRH干预措施都是高度成本效益，然而，应致力于提高这些干预措施的开展和报告成本效益证据的更多努力，使他们可以在政策中使用制作。该审查确定了影响成本效益的潜在因素，并在设计和实施此类干预措施时为决策者提供有用的信息。

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