COST-EFFECTIVENESS OF HOME-BASED CHLORINATION AND SAFE WATER STORAGE IN REDUCING DIARRHEA AMONG HIV-AFFECTED HOUSEHOLDS IN RURAL UGANDA

RAM K. SHRESTHA Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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ELLIOT MARSEILLE Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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JAMES G. KAHN Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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JOHN R. LULE Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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CHRISTIAN PITTER Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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JOHN M. BLANDFORD Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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REBECCA BUNNELL Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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ALEX COUTINHO Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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FRANCIS KIZITO Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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ROBERT QUICK Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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JONATHAN MERMIN Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Health Strategies International, Orinda, CA; Institute for Health Policy Studies, University of California, San Francisco, CA; CDC-Uganda, Global AIDS Program, National Center for HIV, STD, and TB Prevention, and Uganda Virus Research Institute, Entebbe, Uganda; CDC-Uganda and Institute for Global Health and Department of Pediatrics, University of California, San Francisco, CA; The AIDS Support Organization, Entebbe, Uganda; Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, GA

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Safe water systems (SWSs) have been shown to reduce diarrhea and death. We examined the cost-effectiveness of SWS for HIV-affected households using health outcomes and costs from a randomized controlled trial in Tororo, Uganda. SWS was part of a home-based health care package that included rapid diarrhea diagnosis and treatment of 196 households with relatively good water and sanitation coverage. SWS use averted 37 diarrhea episodes and 310 diarrhea-days, representing 0.155 disability-adjusted life year (DALY) gained per 100 person-years, but did not alter mortality. Net program costs were $5.21/episode averted, $0.62/diarrhea-day averted, and $1,252/DALY gained. If mortality reduction had equaled another SWS trial in Kenya, the cost would have been $11/DALY gained. The high SWS cost per DALY gained was probably caused by a lack of mortality benefit in a trial designed to rapidly treat diarrhea. SWS is an effective intervention whose cost-effectiveness is sensitive to diarrhea-related mortality, diarrhea incidence, and effective clinical management.

Author Notes

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