Modelling the impact and cost-effectiveness of the HIV intervention programme amongst commercial sex workers in Ahmedabad, Gujarat, India.

BACKGROUND: Ahmedabad is an industrial city in Gujarat, India. In 2003, the HIV prevalence among commercial sex workers (CSWs) in Ahmedabad reached 13.0%. In response, the Jyoti Sangh HIV prevention programme for CSWs was initiated, which involves outreach, peer education, condom distribution, and free STD clinics. Two surveys were performed among CSWs in 1999 and 2003. This study estimates the cost-effectiveness of the Jyoti Sangh HIV prevention programme. METHODS: A dynamic mathematical model was used with survey and intervention-specific data from Ahmedabad to estimate the HIV impact of the Jyoti Sangh project for the 51 months between the two CSW surveys. Uncertainty analysis was used to obtain different model fits to the HIV/STI epidemiological data, producing a range for the HIV impact of the project. Financial and economic costs of the intervention were estimated from the providers perspective for the same time period. The cost per HIV-infection averted was estimated. RESULTS: Over 51 months, projections suggest that the intervention averted 624 and 5,131 HIV cases among the CSWs and their clients, respectively. This equates to a 54% and 51% decrease in the HIV infections that would have occurred among the CSWs and clients without the intervention. In the absence of intervention, the model predicts that the HIV prevalence amongst the CSWs in 2003 would have been 26%, almost twice that with the intervention. Cost per HIV infection averted, excluding and including peer educator economic costs, was USD 59 and USD 98 respectively. CONCLUSION: This study demonstrated that targeted CSW interventions in India can be cost-effective, and highlights the importance of replicating this effort in other similar settings.Published versio

Restoration of soil quality using biochar and brown coal waste: A review

Soils in intensively farmed areas of the world are prone to degradation. Amendment of such soils with organic waste materials attempts to restore soil quality. Organic amendments are heterogeneous media, which are a source of soil organic matter (SOM) and maintain or restore chemical, physical, biological and ecological functionality. More specifically, an increase in SOM can influence the soil microclimate, microbial community structure, biomass turnover and mineralisation of nutrients. The search is on-going for locally sourced alternatives as many forms may be costly or geographically limiting. The present review focuses on a heterogeneous group of amendments i.e. biochar and brown coal waste (BCW). Both biochar (made from a variety of feedstocks at various temperatures) and BCW (mined extensively) are options that have worldwide applicability. These materials have very high C contents and soil stability, therefore can be used for long-term C sequestration to abate greenhouse gas emissions and as conditioners to improve soil quality. However, biochar is costly for large-scale applications and BCW may have inherently high moisture and pollutant contents. Future studies should focus on the long-term application of these amendments and determine the physicochemical properties of the soil, bioavailability of soil contaminants, diversity of soil communities and productivity of selected crops. Furthermore, the development of in situ technologies to lower production and processing costs of biochar and BCW would improve their economic feasibility for large-scale application