1. Ending the HIV Epidemic Among Persons Who Inject Drugs: A Cost-Effectiveness Analysis in Six US Cities.
- Author
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Krebs, Emanuel, Zang, Xiao, Enns, Benjamin, Min, Jeong E, Behrends, Czarina N, Rio, Carlos Del, Dombrowski, Julia C, Feaster, Daniel J, Gebo, Kelly A, Marshall, Brandon D L, Mehta, Shruti H, Metsch, Lisa R, Pandya, Ankur, Schackman, Bruce R, Strathdee, Steffanie A, Nosyk, Bohdan, Group, Localized HIV Modeling Study, Del Rio, Carlos, and Localized HIV Modeling Study Group
- Subjects
DRUG analysis ,HIV infections ,HIV infection transmission ,EPIDEMICS - Abstract
Background: Persons who inject drugs (PWID) are at a disproportionately high risk of HIV infection. We aimed to determine the highest-valued combination implementation strategies to reduce the burden of HIV among PWID in 6 US cities.Methods: Using a dynamic HIV transmission model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City, and Seattle, we assessed the value of implementing combinations of evidence-based interventions at optimistic (drawn from best available evidence) or ideal (90% coverage) scale-up. We estimated reduction in HIV incidence among PWID, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for each city (10-year implementation; 20-year horizon; 2018 $ US).Results: Combinations that maximized health benefits contained between 6 (Atlanta and Seattle) and 12 (Miami) interventions with ICER values ranging from $94 069/QALY in Los Angeles to $146 256/QALY in Miami. These strategies reduced HIV incidence by 8.1% (credible interval [CI], 2.8%-13.2%) in Seattle and 54.4% (CI, 37.6%-73.9%) in Miami. Incidence reduction reached 16.1%-75.5% at ideal scale.Conclusions: Evidence-based interventions targeted to PWID can deliver considerable value; however, ending the HIV epidemic among PWID will require innovative implementation strategies and supporting programs to reduce social and structural barriers to care. [ABSTRACT FROM AUTHOR]- Published
- 2020
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