Cost-effectiveness of psychological treatment and support interventions for people living with HIV/AIDS: state of the evidence and policy considerations.

backgroundAntiretroviral therapy (ART) has significantly improved the survival and quality of life of people living with HIV (PLHIV). However, many still face persistent physical, emotional, and social challenges. Integrating psychological treatments into HIV care has demonstrated potential for enhancing mental health, improving treatment adherence, and achieving better clinical outcomes. While the effectiveness of these interventions is well-documented, evidence on their cost-effectiveness remains limited and lacks systematic synthesis. This study addresses this gap by evaluating the current evidence on the cost-effectiveness of psychological treatment and support interventions for PLHIV.

methodsA comprehensive search was conducted in PubMed, PsycINFO, Embase, and EconLit via EBSCO for English-language, peer-reviewed studies on the cost-effectiveness of psychological interventions for individuals living with HIV/AIDS. No restrictions were placed on the publication year. Searches were performed in January, June, August, and October 2024, supplemented by citation tracking. Three reviewers independently screened studies in two stages, resolving disagreements through discussion. Data were extracted using a standardized table aligned with Joanna Briggs Institute guidelines to capture study characteristics, interventions, outcomes, and methodologies. Study quality was assessed using the Quality of Health Economic Studies (QHES) instrument.

resultsOut of 3,410 records identified, 2,852 remained after duplicate removal, and eight studies met the inclusion criteria. Studies were conducted in the USA (n = 3), Uganda (n = 3), the Netherlands (n = 1), and Tanzania (n = 1), using randomized controlled trials, observational designs, and modeling approaches. Seven of the eight interventions demonstrated cost-effectiveness when evaluated against country-specific willingness-to-pay thresholds. Reported incremental cost-effectiveness ratios ranged from $13-$397 per DALY averted in low-income settings and $13,316-$36,166 per QALY gained in high-income settings, consistently falling below accepted thresholds. Several interventions showed high probabilities of cost-effectiveness (≥ 94%) and, in some cases, cost savings. One psychosocial group intervention in Tanzania exceeded GDP-based thresholds but was still considered a potentially affordable alternative given limited access to mental health services.

conclusionThe findings indicate that psychological treatment and support interventions for PLHIV are generally cost-effective across both developed and developing settings, enhancing mental health outcomes while optimizing healthcare resource use. However, the evidence base remains limited to eight studies from four countries, underscoring the need for further research across diverse contexts to reinforce the economic case for integrating psychological services into HIV care frameworks.