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Introduction

Here is substantial public health interest in the relationship between alcohol consumption and risky sexual behaviors that can contribute to the spread of sexually transmitted diseases (STDs),including HIV/AIDS (for reviews of this literature, see Donovan and McEwen, 1995; Leigh and Stall, 1993). It is important to note, however, that the study of the relationship between alcohol and high-risk sex has been dominated thus far by research at the level of the individual, with the exception of a very few studies that analyze this association at the level of larger populations (Chess on et al., 2000; Dee, 2001; Gullet, 2002; Scribner et al., 1998).

Despite the limitations of population-wide studies, ecological analyses of changes in alcohol consumption as they relate to changes inset rates can make important contributions to this literature. First, population-wide data on the relationship between alcohol consumption and STD rates provide an independent "real world" window to supplement a literature based primarily on data at the level of the individual. Second, an analysis of population-level data might provide insight into the questions "Could changes nipper capita alcohol consumption in given population have any effect on STD rates?" and "What might be the magnitude of such an effect?" Individual-level studies are not suited to address these questions (Nordstrom and Slog, 2001).

Health Promotional Models

This study has presented an economic evaluation of a comprehensive range of VCT and choices of drug regimen for PMTCT in Thailand. We excluded a long course of AZT, ACTG 076, in our assessment since it is relatively complicated (given intravenous form of AZT to mother during labour) and expensive, and may be difficult to adopt in developing countries [35,36].

There are two major policy concerns in this study: whether to recommend single or double VCT, and which of four drug regimens is the most cost-effective investment per infection averted in a setting with moderately high HIV sero-prevalence in pregnancy. The assessment has proved by both point estimate and multivariate uncertainty analysis that the programme D has a lower cost per paediatric HIV infection averted than other alternatives.

For the choice of VCT, though, we found that 1VCT is less costly than 2VCT. International experience with the accepted cost-utility ratios suggests that cost per Life Year Gained (LYG) or Quality Adjusted Life Year (QALY) threshold is 3 × per capita GDP . This application would presently lead to a threshold value in Thailand of between 21,000 USD per LYG or QALY or 407,000 USD per paediatric HIV infection averted (assuming 19.4 LYG per HIV infection averted and the current practice, programme 2D, clearly represents value for money. Thus, our evidence supports the new policy of the Thai National Perinatal HIV Prevention programme having introduced programme 2D as a national regimen for PMTCT.

This study is partly compatible with one conducted in Mexico, another low HIV prevalence setting, . Both studies similarly identify that VCT has a major share of total programme cost but also is essential to the efficacy of the ART programme ...