Ending the HIV Epidemic Among Persons Who Inject Drugs: A Cost-Effectiveness Analysis in Six US Cities
| Autor: | Krebs, Emanuel, Zang, Xiao, Enns, Benjamin, Min, Jeong E, Behrends, Czarina N, Del Rio, Carlos, Dombrowski, Julia C, Feaster, Daniel J, Gebo, Kelly A, Marshall, Brandon DL, Mehta, Shruti H, Metsch, Lisa R, Pandya, Ankur, Schackman, Bruce R, Strathdee, Steffanie A, Nosyk, Bohdan, Localized HIV Modeling Study Group |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male localized HIV microepidemics Adolescent Cost-Benefit Analysis Localized HIV Modeling Study Group HIV Infections Economic Medical and Health Sciences Microbiology Drug Users HIV Testing Young Adult Cost of Illness injection drug use Models Prevalence Opiate Substitution Treatment Humans Cities Epidemics cost-effectiveness interventions Incidence Substance Abuse Health Plan Implementation HIV Health Care Costs Middle Aged Biological Sciences United States Female Pre-Exposure Prophylaxis Preventive Medicine Quality-Adjusted Life Years dynamic HIV transmission mode Intravenous |
| Zdroj: | The Journal of infectious diseases, vol 222, iss Suppl 5 |
| Popis: | BackgroundPersons 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.MethodsUsing 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).ResultsCombinations 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.ConclusionsEvidence-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. |
| Databáze: | OpenAIRE |
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