1. The impact of localized implementation: determining the cost-effectiveness of HIV prevention and care interventions across six United States cities.
- Author
-
Krebs, Emanuel, Zang, Xiao, Enns, Benjamin, Min, Jeong E, Behrends, Czarina N, Del Rio, Carlos, Dombrowski, Julia C, Feaster, Daniel J, Gebo, Kelly A, Golden, Matthew, Marshall, Brandon DL, Metsch, Lisa R, Schackman, Bruce R, Shoptaw, Steven, Strathdee, Steffanie A, and Nosyk, Bohdan
- Subjects
Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Sciences ,Infectious Diseases ,HIV/AIDS ,Health Services ,Sexually Transmitted Infections ,Behavioral and Social Science ,Clinical Research ,Cost Effectiveness Research ,Health Disparities ,Prevention ,Mental Health ,Minority Health ,Comparative Effectiveness Research ,8.1 Organisation and delivery of services ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Infection ,Good Health and Well Being ,Baltimore ,Cities ,Cost-Benefit Analysis ,HIV Infections ,Homosexuality ,Male ,Humans ,Male ,New York City ,Primary Prevention ,Quality-Adjusted Life Years ,Sexual and Gender Minorities ,United States ,cost-effectiveness ,dynamic HIV transmission model ,HIV ,implementation ,interventions ,localized HIV micro epidemics ,Localized Economic Modeling Study Group ,Biological Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Virology ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectiveEffective interventions to reduce the public health burden of HIV/AIDS can vary in their ability to deliver value at different levels of scale and in different epidemiological contexts. Our objective was to determine the cost-effectiveness of HIV treatment and prevention interventions implemented at previously documented scales of delivery in six US cities with diverse HIV microepidemics.DesignDynamic HIV transmission model-based cost-effectiveness analysis.MethodsWe identified and estimated previously documented scale of delivery and costs for 16 evidence-based interventions from the US CDC's Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention. Using a model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City and Seattle, we estimated averted HIV infections, quality-adjusted life years (QALY) gained and incremental cost-effectiveness ratios (healthcare perspective; 3% discount rate, 2018$US), for each intervention and city (10-year implementation) compared with the status quo over a 20-year time horizon.ResultsIncreased HIV testing was cost-saving or cost-effective across cities. Targeted preexposure prophylaxis for high-risk MSM was cost-saving in Miami and cost-effective in Atlanta ($6123/QALY), Baltimore ($18 333/QALY) and Los Angeles ($86 117/QALY). Interventions designed to improve antiretroviral therapy initiation provided greater value than other treatment engagement interventions. No single intervention was projected to reduce HIV incidence by more than 10.1% in any city.ConclusionCombination implementation strategies should be tailored to local epidemiological contexts to provide the most value. Complementary strategies addressing factors hindering access to HIV care will be necessary to meet targets for HIV elimination in the United States.
- Published
- 2020