Bergmann, J.N., Legins, K., Sint, T.T., et al. AIDS and Behavior (April 2016), e-publication ahead of print.
This paper examined the impact and cost-effectiveness of integrated HIV and nutrition service delivery small-scale pilot programs supported by the United Nations Children's Fund in Malawi and Mozambique. The authors used a four-step process to analyze program impact and cost-effectiveness: (1) identifying key components of a program; (2) linking program components to outcome indicators; (3) measuring trends in outcome indicators; and (4) analyzing cost-effectiveness. They presented separate results for each country. The integrated program in Malawi included use of text messaging technology; training and deployment of male motivators; and the creation and implementation of "child health passports." The integrated program in Mozambique was implemented in two provinces and comprised four key components: one-stop shops, flowcharts to streamline services and demonstrations of proper nutrition, and expansion of early infant diagnostic services. Cost-effectiveness in the Malawi program was USD$11–29 per disability-adjusted life year (DALY), while that in Mozambique’s program was USD$16–59/DALY. However, some components were more effective than others ($1–4/DALY for Malawi’s male motivators compared to $179/DALY for Mozambique’s one-stop shops). The authors concluded that integrating HIV and nutrition programming led to positive impacts on health outcomes.