Balancing research investment with practical application in African HIV interventions.

The Right Size: How to Optimize Alcohol Intervention Trials for HIV Patients in East Africa

Elliot Brynn in Health & Wellness November 2025 • 4 min read.

"Value of information methods offer a data-driven approach to determining the right sample size, ensuring effective and cost-efficient HIV prevention strategies."

In East Africa, unhealthy alcohol use significantly exacerbates the HIV epidemic, contributing to risky sexual behaviors and reduced adherence to antiretroviral therapies (ART). Addressing alcohol consumption is crucial, and testing the effectiveness of alcohol interventions through clinical trials is essential. However, traditional sampling methods often fall short in evaluating the potential benefits and cost-effectiveness of such trials.

Given the scarcity of healthcare resources in East Africa, it's vital to ensure that funds allocated to clinical trials are used efficiently. There's an opportunity cost to consider: could those funds be better spent on implementing existing, cost-effective alcohol treatments? This question highlights the need for a more strategic approach to determining the optimal sample size for intervention trials.

Value of information (VOI) methods offer a powerful alternative. VOI helps decision-makers determine the optimal sample size by maximizing the expected net benefit of sampling. It considers a policymaker's willingness to pay for the health benefits of an intervention and balances the cost of the trial against the potential value of the information gained.

Unlocking Efficient HIV Prevention: Value of Information Methods in Action

Balancing research investment with practical application in African HIV interventions.

Researchers Lingfeng Li, Jennifer Uyei, Kimberly A. Nucifora, and colleagues used VOI methods to assess the optimal sample size for a hypothetical randomized controlled trial (RCT) evaluating a 2-arm alcohol intervention versus a control. Their analysis considered various factors, including policymaker's willingness to pay for the intervention's health benefits and the potential for re-allocating trial funds to cost-effective alcohol treatments.

The team imputed probability distributions describing the likelihood of alternative trial results, drawing on prior studies. In the base case, the policymaker's willingness to pay was based on a resource-constrained priority: routine HIV virological testing. They also performed sensitivity analyses for varying willingness-to-pay thresholds and intervention durations.

Base Case Scenario: With the base case willingness-to-pay threshold and a 20-year intervention duration, a new effectiveness trial would benefit East Africa by $67,000, with an optimal sample size of 100 persons per arm.
Conservative and High Willingness-to-Pay: At both a conservative willingness-to-pay (1 x GDP/capita) and a high willingness-to-pay (3 x GDP/capita), a new trial wasn't recommended due to limited decision uncertainty.
Shorter Intervention Durations: When the intervention duration was 10 or 5 years, there was no return on investment across suggested willingness-to-pay thresholds.

These findings highlight the importance of considering intervention duration and resource constraints when planning clinical trials. VOI methods provide a valuable framework for making data-driven decisions about sample size, ensuring that resources are used efficiently and effectively.

The Future of Alcohol Intervention Trials: A Call for Strategic Design

Value of information methods offer a promising approach to assist in the efficient design of alcohol trials. If reducing unhealthy alcohol use is a long-term goal for HIV programs in East Africa, additional new trials with optimal sample sizes ranging from 100 to 250 persons per arm could save the opportunity cost of implementing less cost-effective alcohol strategies. However, if long-term implementation isn't feasible, conducting a new trial might not be recommended.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

How does unhealthy alcohol use impact the HIV epidemic in East Africa, and why are clinical trials important in addressing this issue?

In East Africa, unhealthy alcohol use significantly worsens the HIV epidemic by increasing risky sexual behaviors and decreasing adherence to antiretroviral therapies (ART). Clinical trials are needed to test alcohol intervention effectiveness, and value of information (VOI) methods offer a way to optimize sample size and ensure cost-effectiveness. Traditional methods might not fully capture the benefits and cost-effectiveness of these trials in resource-limited settings.

What are value of information (VOI) methods, and how do they help in determining the optimal sample size for alcohol intervention trials?

Value of information (VOI) methods help determine the ideal sample size for clinical trials by maximizing the expected net benefit. This involves weighing what a policymaker is willing to pay for the health benefits against the trial's cost. VOI allows for efficient resource allocation by balancing trial costs with the potential value of gained information. The approach considers the opportunity cost such as whether funds might be better used on existing cost-effective alcohol treatments.

What key findings and conclusions were reached using value of information (VOI) methods to assess the optimal sample size for alcohol intervention trials, and how do willingness-to-pay and intervention duration influence these findings?

In the base case scenario described, with the specified willingness-to-pay threshold and a 20-year intervention duration, a new effectiveness trial would benefit East Africa by $67,000, with an optimal sample size of 100 persons per arm. However, at both a conservative willingness-to-pay (1 x GDP/capita) and a high willingness-to-pay (3 x GDP/capita), a new trial wasn't recommended due to limited decision uncertainty. Also, when the intervention duration was 10 or 5 years, there was no return on investment across suggested willingness-to-pay thresholds.

How can value of information (VOI) methods contribute to the future of alcohol intervention trials in East Africa, and what conditions would make a new trial more or less beneficial?

Value of information (VOI) methods support the efficient design of alcohol trials in East Africa. If the goal is to reduce unhealthy alcohol use in HIV programs long-term, additional new trials with sample sizes from 100 to 250 persons per arm could save the opportunity cost of implementing less cost-effective alcohol strategies. However, if long-term implementation isn't feasible, a new trial might not be recommended, emphasizing the importance of strategic planning.

What is the advantage of using value of information (VOI) methods over traditional approaches for determining sample size in alcohol intervention trials for HIV patients in resource-constrained settings?

Value of information (VOI) methods offer a structured way to make data-driven decisions about sample size, ensuring that resources are used efficiently and effectively in clinical trials. Traditional sample size calculations often fail to account for opportunity costs, such as whether funds could be better spent on existing cost-effective interventions. VOI integrates economic considerations and decision-maker preferences, making it especially valuable in resource-constrained settings like East Africa.