Integrated HIV Testing, Malaria, and Diarrhea Prevention Campaign in Kenya: Modeled Health Impact and Cost- Effectiveness James G. Kahn 1 *, Nicholas Muraguri 2 , Brian Harris 1 , Eric Lugada 3 , Thomas Clasen 4 , Mark Grabowsky 5 , Jonathan Mermin 6 , Shahnaaz Shariff 2 1 Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, United States of America, 2 Ministry of Public Health and Sanitation, Government of Kenya, Nairobi, Kenya, 3 CHF International, Nairobi, Kenya, 4 London School of Hygiene & Tropical Medicine, London, United Kingdom, 5 ESP/UN Foundation, Washington, D.C., United States of America, 6 Coordinating Office for Global Health, CDC, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya Abstract Background: Efficiently delivered interventions to reduce HIV, malaria, and diarrhea are essential to accelerating global health efforts. A 2008 community integrated prevention campaign in Western Province, Kenya, reached 47,000 individuals over 7 days, providing HIV testing and counseling, water filters, insecticide-treated bed nets, condoms, and for HIV-infected individuals cotrimoxazole prophylaxis and referral for ongoing care. We modeled the potential cost-effectiveness of a scaled-up integrated prevention campaign. Methods: We estimated averted deaths and disability-adjusted life years (DALYs) based on published data on baseline mortality and morbidity and on the protective effect of interventions, including antiretroviral therapy. We incorporate a previously estimated scaled-up campaign cost. We used published costs of medical care to estimate savings from averted illness (for all three diseases) and the added costs of initiating treatment earlier in the course of HIV disease. Results: Per 1000 participants, projected reductions in cases of diarrhea, malaria, and HIV infection avert an estimated 16.3 deaths, 359 DALYs and $85,113 in medical care costs. Earlier care for HIV-infected persons adds an estimated 82 DALYs averted (to a total of 442), at a cost of $37,097 (reducing total averted costs to $48,015). Accounting for the estimated campaign cost of $32,000, the campaign saves an estimated $16,015 per 1000 participants. In multivariate sensitivity analyses, 83% of simulations result in net savings, and 93% in a cost per DALY averted of less than $20. Discussion: A mass, rapidly implemented campaign for HIV testing, safe water, and malaria control appears economically attractive. Citation: Kahn JG, Muraguri N, Harris B, Lugada E, Clasen T, et al. (2012) Integrated HIV Testing, Malaria, and Diarrhea Prevention Campaign in Kenya: Modeled Health Impact and Cost-Effectiveness. PLoS ONE 7(2): e31316. doi:10.1371/journal.pone.0031316 Editor: Claire Thorne, UCL Institute of Child Health, University College London, United Kingdom Received June 30, 2011; Accepted January 5, 2012; Published February , 2012 Copyright: ß 2012 Kahn et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was funded by Vestergaard Frandsen and by the U.S. National Institute for Drug Abuse, under R01 DA15612. Neither funder exerted any editorial control. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: Brian Harris was hired by Super Models for Global Health (Dr. Kahn) to monitor the IPC in Kakamega in September 2008, and to do an analysis afterward. SMGH was paid by Vestergaard Frandsen. Vestergaard Frandsen paid J. G. Kahn (SMGH) to conduct the analysis and writing the manuscript. VF also paid for J. G. Kahn’s travel to two meetings to present study results. London Vestergaard Frandsen paid for T. Clasen’s field visit to Kenya study site and fees for time spent on study. This does not alter the authors’ adherence to all the PLoS ONE policies on sharing data and materials. The other authors have no conflicts of interest to declare. * E-mail: jgkahn@ucsf.edu Introduction The potential role of cost-effectiveness analysis in global health decision-making is increasingly recognized [1]. Interventions vary substantially in their ability to deliver health value per amount expended. The value of global health spending can be maximized by prioritizing cost-effective interventions [2]. Differences in cost-effectiveness reflect several factors: the prevalence and severity of disease, the protective effect offered by interventions, and — the only factor substantially under operational control — how efficiently services are delivered. Innovations in delivery strategies may offer substantial savings in cost per person served, as well as greater coverage. These strategies may include a community or health facility focus, as well as streamlining of health care processes [3–5]. They can include multiple disease interven- tions delivered simultaneously, offering the potential to share fixed costs (such as reaching into communities) while addressing multiple high disease burdens. However, little attention has been paid to the economics of multi-disease intervention delivery. In a separate report, we examined the cost of a multi-disease 7- day integrated prevention campaign (IPC) in Western Province, Kenya, that was implemented in 2008 in 30 village centers [6,7]. The IPC provided HIV testing and counseling, water filters, insecticide-treated bed nets, condoms, and for HIV-infected individuals CD4 count enumeration, 3 months of cotrimoxazole, and referral to care. Ongoing community mobilization, including PLoS ONE | www.plosone.org 1 February 2012 | Volume 7 | Issue 2 | e31316 8