The cost-effectiveness of a resilience-based psychosocial intervention for HIV prevention among MSM in India.

Autor:	Kazemian P; Department of Operations, Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio., Ding DD; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts., Scott JA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts., Feser MK; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts., Biello K; Center for Health Promotion and Health Equity.; Department of Behavioral and Social Sciences.; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.; The Fenway Institute, Fenway Health, Boston, Massachusetts, USA., Thomas BE; National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu., Dange A; The Humsafar Trust, Mumbai, Maharashtra, India., Bedoya CA; Behavioral Medicine Program, Massachusetts General Hospital.; Harvard Medical School, Boston, Massachusetts, USA., Balu V; National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu., Rawat S; The Humsafar Trust, Mumbai, Maharashtra, India., Kumarasamy N; CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services, Chennai, Tamil Nadu, India., Mimiaga MJ; The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.; Department of Epidemiology, UCLA Fielding School of Public Health.; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine.; UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, California., O'Cleirigh C; The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.; Behavioral Medicine Program, Massachusetts General Hospital.; Harvard Medical School, Boston, Massachusetts, USA., Weinstein MC; Department of Health Policy and Management.; Department of Biostatistics., Kumar JP; National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu., Kumar S; The Humsafar Trust, Mumbai, Maharashtra, India., Mayer KH; The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; Department of Global Health and Population, Harvard T.H. Chan School of Public Health.; Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts., Safren SA; Center for HIV and Research in Mental Health.; Health Promotion and Care Research Program.; Department of Psychology, University of Miami, Miami, Florida., Freedberg KA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts, USA.; Department of Health Policy and Management.; Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts.; Division of General Internal Medicine.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	AIDS (London, England) [AIDS] 2022 Jul 15; Vol. 36 (9), pp. 1223-1232. Date of Electronic Publication: 2022 Apr 26.
DOI:	10.1097/QAD.0000000000003231
Abstrakt:	Objective: MSM in India are at a high risk for HIV infection given psychosocial challenges, sexual orientation stress, and stigma. We examined the cost-effectiveness of a novel resilience-based psychosocial intervention for MSM in India. Design: We parameterized a validated microsimulation model (CEPAC) with India-specific data and results from a randomized trial and examined two strategies for MSM: status quo HIV care ( SQ ), and a trial-based psychosocial intervention ( INT ) focused on building resilience to stress, improving mental health, and reducing condomless anal sex (CAS). Methods: We projected lifetime clinical and economic outcomes for MSM without HIV initially. Intervention effectiveness, defined as reduction in self-reported CAS, was estimated at 38%; cost was $49.37/participant. We used a willingness-to-pay threshold of US$2100 (2019 Indian per capita GDP) per year of life saved (YLS) to define cost-effectiveness. We also assessed the 5-year budget impact of offering this intervention to 20% of Indian MSM. Results: Model projections showed the intervention would avert 2940 HIV infections among MSM over 10 years. Over a lifetime horizon, the intervention was cost-effective (ICER = $900/YLS). Results were most sensitive to intervention effectiveness and cost; the intervention remained cost-effective under plausible ranges of these parameters. Offering this intervention in the public sector would require an additional US$28 M over 5 years compared with SQ . Conclusion: A resilience-based psychosocial intervention integrated with HIV risk reduction counseling among MSM in India would reduce HIV infections and be cost-effective. Programs using this approach should be expanded as a part of comprehensive HIV prevention in India. (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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