{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:04:09Z","timestamp":1785452649938,"version":"3.56.0"},"reference-count":34,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"unspecified","delay-in-days":57,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006661","name":"United Nations Population Fund","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/100006661","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,2,6]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Among youth in Cambodia, there is low awareness of HIV and sexually transmitted infection (STI) risk, and the prevalence of unintended pregnancies is high. We aimed to quantify the health and economic benefits of reaching the 2025 Joint United Nations Programme on HIV\/AIDS (UNAIDS) target of 95% coverage of combination HIV prevention\/testing packages for young key population groups as well as providing comprehensive sexuality education (CSE) for all youth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The model considered 10\u201319-year olds in Cambodia, disaggregated by key population group (young men who have sex with men, young transgender persons, young people who use drugs, young female entertainment workers) and in-school\/out-of-school status. Three scenarios were projected over 2023\u20132030: (1) a baseline scenario with fixed intervention coverage; (2) a scenario scaling up existing HIV\/STI prevention and testing interventions for young key populations through multiple delivery modalities, plus in-school CSE, over 2024\u20132025 to reach 95% coverage (maintained until 2030); and (3) scenario 2 plus an additional out-of-school CSE programme for all being implemented and scaled to 95% coverage. HIV infections, unintended pregnancies, maternal deaths and stillbirths averted were converted to economic benefits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Scenario 2 costs US$10.6\u2009million more than the baseline scenario over 2023\u20132030, and averted 1184 HIV infections, 10\u2009172 unintended pregnancies, 16 maternal deaths and 106 stillbirths. This investment could generate US$36.1\u2009million in economic benefits by 2050, with a benefit\u2013cost ratio of 3.4. Scenario 3, including out-of-school CSE, achieved additional health benefits; however, it was less cost-effective than in-school CSE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Investment in HIV prevention\/testing packages for young key population groups and CSE programmes can have favourable returns in Cambodia. Strategies to maintain high levels of school enrolment can facilitate cost-effective ways to expand CSE coverage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-002209","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T14:35:22Z","timestamp":1772202922000},"page":"e002209","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Cost\u2013benefit analysis of adolescent HIV\/STI prevention and comprehensive sexuality education interventions in Cambodia: a modelling study"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6377-7859","authenticated-orcid":false,"given":"Tharindu","family":"Wickramaarachchi","sequence":"first","affiliation":[{"name":"Modelling and Biostatistics, Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vutha","family":"Phon","sequence":"additional","affiliation":[{"name":"United Nations Population Fund, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Bernklau","sequence":"additional","affiliation":[{"name":"United Nations Population Fund, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Sladden","sequence":"additional","affiliation":[{"name":"United Nations Population Fund, Asia and the Pacific Regional Office, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowan","family":"Martin-Hughes","sequence":"additional","affiliation":[{"name":"Modelling and Biostatistics, Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Scott","sequence":"additional","affiliation":[{"name":"Modelling and Biostatistics, Burnet Institute, Melbourne, Victoria, Australia"},{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"2026022706351504000_4.1.e002209.1","unstructured":"UNAIDS . Feature Story Cambodia social protection for people living with HIV, 2023. Available: https:\/\/www.unaids.org\/en\/resources\/presscentre\/featurestories\/2023\/december\/20231215_cambodia"},{"key":"2026022706351504000_4.1.e002209.2","unstructured":"UNAIDS . Cambodia country data. 2023. Available: https:\/\/www.aidsdatahub.org\/sites\/default\/files\/resource\/cambodia-data-book-2023.pdf"},{"key":"2026022706351504000_4.1.e002209.3","unstructured":"UNAIDS . Cambodia hiv estimates. 2022. Available: https:\/\/www.unaids.org\/en\/regionscountries\/countries\/cambodia [Accessed 9 Aug 2023]."},{"key":"2026022706351504000_4.1.e002209.4","unstructured":"UNAIDS . Cambodia: Technical note on national and sub-national HIV estimates and projections, 2019. Available: https:\/\/www.aidsdatahub.org\/sites\/default\/files\/resource\/cambodia-national-and-subnational-hiv-estimates-and-projections-2019_0.pdf [Accessed 9 Aug 2023]."},{"key":"2026022706351504000_4.1.e002209.5","unstructured":"National Center for HIV\/AIDS Dermatology and STD (NCHADS) . Integrated biological and behavioral survey among men who have sex with men and transgender women in cambodia. 2019. Available: https:\/\/www.nchads.gov.kh\/wpcontent\/uploads\/2021\/03\/IBBS_MSM_n_TW_2019_eng.pdf [Accessed 9 Aug 2023]."},{"key":"2026022706351504000_4.1.e002209.6","unstructured":"National Center for HIV\/AIDS Dermatology and STD (NCHADS) . Integrated hiv bio-behavioral surveillance survey (ibbs) among female entertainment workers in cambodia. 2022. Available: https:\/\/www.aidsdatahub.org\/sites\/default\/files\/resource\/cambodia-few-ibbs-2022.pdf [Accessed 9 Aug 2023]."},{"key":"2026022706351504000_4.1.e002209.7","unstructured":"National Center for HIV\/AIDS Dermatology and STD (NCHADS) . National population size estimation, integrated biological and behavioral survey, and hcv among pwid and pwud in cambodia, 2017. 2017. Available: https:\/\/www.aidsdatahub.org\/sites\/default\/files\/resource\/cambodia-ibbs-pwid-pwud-2017.pdf"},{"key":"2026022706351504000_4.1.e002209.8","unstructured":"National Center for HIV\/AIDS Dermatology and STDs (NCHADS) . Focusing and sustaining the HIV response in Cambodia: findings from an optima HIV modelling analysis. 2023."},{"key":"2026022706351504000_4.1.e002209.9","unstructured":"Cambodia Contraception within the context of adolescents\u2019 sexual and reproductive lives: Country profile [press release]. 2020."},{"key":"2026022706351504000_4.1.e002209.10","unstructured":"National Institute of Statistics (NIS) [Cambodia], Ministry of Health (MoH) [Cambodia], and ICF . Cambodia demographic and health survey 2021\u201322: key indicators report. Phnom Penh (Cambodia) and Rockville, MD (USA): NIS, MoH, and ICF, 2022."},{"key":"2026022706351504000_4.1.e002209.11","unstructured":"UNFPA, UNICEF, WFP, UNAIDS . Youth situation analysis in Cambodia. 2020."},{"key":"2026022706351504000_4.1.e002209.12","unstructured":"Ministry of Health Cambodia . National strategy for reproductive and sexual health in Cambodia 2017\u20102020. Phnom Penh, Cambidia, 2017."},{"key":"2026022706351504000_4.1.e002209.13","unstructured":"Swedish Association for Sexuality Education (RFSU) . Cambodia is investing in sex education. 2025. Available: https:\/\/www.rfsu.se\/en\/this-is-rfsu\/in-english\/news\/2025\/cambodia-is-investing-in-sex-education"},{"key":"2026022706351504000_4.1.e002209.14","unstructured":"UNFPA . From silence to dialogue: comprehensive sexuality education changed the teenager\u2019s communication behavior. 2025."},{"key":"2026022706351504000_4.1.e002209.15","doi-asserted-by":"crossref","first-page":"100048","DOI":"10.1016\/j.conx.2020.100048","article-title":"Sex education and contraceptive use of adolescent and young adult females in the United States: an analysis of the National Survey of Family Growth 2011\u20132017","volume":"2","author":"Cheedalla","year":"2020","journal-title":"Contraception: X"},{"key":"2026022706351504000_4.1.e002209.16","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000002951"},{"key":"2026022706351504000_4.1.e002209.17","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2110877119"},{"key":"2026022706351504000_4.1.e002209.18","unstructured":"National Institute of Statistics Cambodia . General population census of Cambodia 2019. 2020."},{"key":"2026022706351504000_4.1.e002209.19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1728-4465.2012.00324.x"},{"key":"2026022706351504000_4.1.e002209.20","unstructured":"Planned Parenthood Mar Monte . Education and outreach. 2023. Available: https:\/\/www.plannedparenthood.org\/planned-parenthood-mar-monte\/local-education-training"},{"key":"2026022706351504000_4.1.e002209.21","doi-asserted-by":"publisher","DOI":"10.1093\/her\/cyr093"},{"key":"2026022706351504000_4.1.e002209.22","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1007\/s11121-020-01153-z","article-title":"Association of HIV Education with HIV Testing and Sexual Risk Behaviors Among US Youth, 2009\u20132017: Disparities Between Sexual Minority and Sexual Majority Youth","volume":"21","author":"Phillips","year":"2020","journal-title":"Prev Sci"},{"key":"2026022706351504000_4.1.e002209.23","doi-asserted-by":"publisher","DOI":"10.1521\/aeap.2009.21.3.181"},{"key":"2026022706351504000_4.1.e002209.24","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jadohealth.2016.08.025","article-title":"The Impact of a Sexual and Reproductive Health Intervention for American Indian Adolescents on Predictors of Condom Use Intention","volume":"60","author":"Tingey","year":"2017","journal-title":"J Adolesc Health"},{"key":"2026022706351504000_4.1.e002209.25","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1093\/heapro\/daz108","article-title":"Online STI information seeking behaviour and condom use intentions among young Facebook users in Malaysia","volume":"35","author":"Mohamad Shakir","year":"2020","journal-title":"Health Promot Int"},{"key":"2026022706351504000_4.1.e002209.26","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/QAI.0000000000002951","article-title":"Role of Schooling and Comprehensive Sexuality Education in Reducing HIV and Pregnancy Among Adolescents in South Africa","volume":"90","author":"George","year":"2022","journal-title":"JAIDS Journal of Acquired Immune Deficiency Syndromes"},{"key":"2026022706351504000_4.1.e002209.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-12281-8","article-title":"The role and effectiveness of School-based Extra-Curricular Interventions on children\u2019s health and HIV related behaviour: the case study of Soul Buddyz Clubs Programme in South Africa","volume":"21","author":"Letsela","year":"2021","journal-title":"BMC Public Health"},{"key":"2026022706351504000_4.1.e002209.28","doi-asserted-by":"crossref","DOI":"10.2196\/14230","article-title":"Using Digital Communication Technology to Increase HIV Testing Among Men Who Have Sex With Men and Transgender Women: Systematic Review and Meta-Analysis","volume":"22","author":"Veronese","year":"2020","journal-title":"J Med Internet Res"},{"key":"2026022706351504000_4.1.e002209.29","doi-asserted-by":"crossref","first-page":"e626","DOI":"10.1016\/S2468-2667(22)00117-7","article-title":"Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): a cluster-randomised trial","volume":"7","author":"Lohan","year":"2022","journal-title":"Lancet Public Health"},{"key":"2026022706351504000_4.1.e002209.30","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.0050224","article-title":"The long-term effects of a peer-led sex education programme (RIPPLE): a cluster randomised trial in schools in England","volume":"5","author":"Stephenson","year":"2008","journal-title":"PLoS Med"},{"key":"2026022706351504000_4.1.e002209.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2014.04.017"},{"key":"2026022706351504000_4.1.e002209.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003790","article-title":"Bridging the gap: Enhancing HIV care pathways for young key populations in Chad","volume":"5","author":"Bedingar","year":"2025","journal-title":"PLOS Glob Public Health"},{"key":"2026022706351504000_4.1.e002209.33","doi-asserted-by":"crossref","first-page":"8","DOI":"10.7448\/IAS.18.2.19434","article-title":"Tailored combination prevention packages and PrEP for young key populations","volume":"18","author":"Pettifor","year":"2015","journal-title":"J Int AIDS Soc"},{"key":"2026022706351504000_4.1.e002209.34","unstructured":"WHO . Health financing and economics. 2025. Available: https:\/\/www.who.int\/teams\/health-systems-governance-and-financing\/economic-analysis\/costing-and-technical-efficiency\/quantities-and-unit-prices-(cost-inputs)\/programme-costs-in-the-economic-evaluation-of-health-interventions"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2024-002209","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T14:35:30Z","timestamp":1772202930000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2024-002209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,27]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjph-2024-002209"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2024-002209","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}