Impact and cost-effectiveness of non-governmental organizations on the HIV epidemic in Ukraine among men who have sex with men

OBJECTIVE: Non-governmental organisations (NGOs) in Ukraine have provided HIV testing, treatment, and condom distribution for men who have sex with men (MSM). HIV prevalence among MSM in Ukraine is 5.6%. We estimated the impact and cost-effectiveness of MSM-targeted NGO activities in Ukraine. DESIGN: A mathematical model of HIV transmission among MSM was calibrated to data from Ukraine (2011-2018). METHODS: The model, designed before the 2022 Russian invasion of Ukraine, evaluated the impact of 2018 status quo (SQ) coverage levels of 28% of MSM being NGO clients over 2016-2020 and 2021-2030 compared to no NGO activities over these time periods. Impact was measured in HIV incidence and infections averted. We compared the costs and disability adjusted life years [DALYs] for the SQ and a counterfactual scenario (no NGOs 2016-2020, but with NGOs thereafter) until 2030 to estimate the mean incremental cost-effectiveness ratio (ICER, cost per DALY averted). RESULTS: Without NGO activity over 2016-2020, the HIV incidence in 2021 would have been 44% (95%CrI: 36%-59%) higher than with SQ levels of NGO activity, with 25% (21-30%) more incident infections occurring over 2016-2020. Continuing with SQ NGO coverage levels will decrease HIV incidence by 41% over 2021-2030, whereas it will increase by 79% (60-120%) with no NGOs over this period and 37% (30-51%) more HIV infections will occur. Compared to if NGO activities had ceased over 2016-2020 (but continued thereafter), the SQ scenario averts 14,918 DALYs over 2016-2030 with a mean ICER of US$600.15 per DALY averted. CONCLUSIONS: MSM-targeted NGOs in Ukraine have prevented considerable HIV infections and are highly cost-effective compared with a willingness-to-pay threshold of 50% of Ukraine’s 2018 GDP (US$1,548).