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This study aimed to estimate the cost-effectiveness and return on investment of HIV programs implemented during 2003-2010 in Indonesia and to contribute to the allocative efficiency of the HIV prevention response in Indonesia through analyses to inform the prioritization of resources for the 2015-2019 national HIV budget in the context of reductions in international donor funding. The spending-outcome relationships and epidemiological model were used to compare observed conditions with counterfactual scenarios of reduced/no programs to calculate he cost-effectiveness and estimate healthcare costs saved and thus the return on investment. Model simulations of epidemic projections over many combinations of possible resource allocations were used to identify optimal allocations for reducing new infections over the next HIV budget period.

Disease Control and Prevention --- Health Economics and Finance --- Health, Nutrition and Population --- Public Health Promotion --- Public Sector Development

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Compulsory drug detention centers (CDDCs) are common throughout Asia. However, medical treatments for substance use disorders, such as opioid agonist treatment (OAT), are generally unavailable in these settings. In this report, the authors compare the effectiveness of CDDCs with voluntary drug treatment centers (VTCs) offering OAT in Malaysia. Positive urine drug testing (UDT) after release confirmed opioid relapse in both groups. Specifically, the authors measure the timing of relapse, that is, the authors compare when patients that have been discharged from CDDCs and VTCs relapse to opioid. The authors conducted a study on opioid dependent individuals from Malaysian CDDCs and VTCs from August 2012 to September 2014. Baseline (at the starting point of the study) and semi-monthly behavioral assessments and UDTs were conducted for up to one year after release and discharge. Relapse rates between the groups were compared using advanced statistical analysis. Screening occurred in 168 CDDC attendees and 113 VTC in-patients, with 89 (CDDC), and 95 (VTC) of these individuals, respectively, having a baseline interview and at least one UDT. The authors found that opioid-dependent persons that have been released from CDDCs relapse to opioid use significantly faster than those from VTC services. This suggests the services provided by CDDCs have little role in the treatment of opioid use disorders.

Alcohol and Substance Abuse --- Communicable Diseases --- Disease Control and Prevention --- Health Service Management and Delivery --- Health, Nutrition and Population --- Public Health Promotion --- World Health Organization