# Impact and cost-effectiveness of the community-led AMETHIST intervention among female sex workers in Zimbabwe

## TL;DR

A community-led intervention called AMETHIST improved HIV outcomes and was cost-effective for female sex workers in Zimbabwe.

## Contribution

The study evaluates the long-term impact and cost-effectiveness of the AMETHIST intervention in reducing HIV transmission among female sex workers.

## Key findings

- AMETHIST led to higher HIV testing, diagnosis, ART use, and undetectable viral loads among female sex workers.
- The intervention averted disability-adjusted life years and was cost-saving within 15 years.
- Continuing the current KP programme was also more cost-effective than discontinuing it.

## Abstract

Female sex workers (FSW) face high HIV risk of HIV transmission and acquisition. The AMETHIST (“Adapted Microplanning: Eliminating Transmissible HIV In Sex Transactions”) trial enhanced Zimbabwe’s Key Populations (KP) programme by providing targeted, community-based support for FSW. We used the HIV Synthesis Model to assess its long-term impact and cost-effectiveness. Given USAID’s major role in funding, we also evaluated the effects of ending US support on the KP programme. We modelled a KP programme from 2010. From 2024 we compared (i) continuation of KP programme to (ii) continuation of KP programme + ‘AMETHIST’ intervention. We assessed HIV outcomes in 2030 and conducted cost-effectiveness analysis over a 50 year time horizon. Similar analyses were undertaken comparing continuation of the current KP programme to discontinuation. Here we show that AMETHIST had greater positive impact than the KP programme alone; a higher proportion of FSW tested for HIV in the past year, were diagnosed, on ART and had undetectable viral loads compared to the KP programme alone. Disability adjusted life years were averted with AMETHIST and it was cost-saving within 15 years. Continuing the current KP programme was also cost-saving compared to discontinuation of the KP programme.

Female sex workers in East, Central and South Africa are a high-risk group for HIV infection. Here, the authors model the potential impact and cost effectiveness of a community-based support intervention for female sex workers in Zimbabwe.