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Jacobson EU, Hicks KA, Carrico J, Purcell DW, Green TA, Mermin JH, Farnham PG. Optimizing HIV Prevention Efforts to Achieve EHE Incidence Targets. J Acquir Immune Defic Syndr 2022; 89:374-380. [PMID: 35202046 PMCID: PMC8887784 DOI: 10.1097/qai.0000000000002885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND A goal of the US Department of Health and Human Services' Ending the HIV Epidemic (EHE) in the United States initiative is to reduce the annual number of incident HIV infections in the United States by 75% within 5 years and by 90% within 10 years. We developed a resource allocation analysis to understand how these goals might be met. METHODS We estimated the current annual societal funding [$2.8 billion (B)/yr] for 14 interventions to prevent HIV and facilitate treatment of infected persons. These interventions included HIV testing for different transmission groups, HIV care continuum interventions, pre-exposure prophylaxis, and syringe services programs. We developed scenarios optimizing or reallocating this funding to minimize new infections, and we analyzed the impact of additional EHE funding over the period 2021-2030. RESULTS With constant current annual societal funding of $2.8 B/yr for 10 years starting in 2021, we estimated the annual incidence of 36,000 new cases in 2030. When we added annual EHE funding of $500 million (M)/yr for 2021-2022, $1.5 B/yr for 2023-2025, and $2.5 B/yr for 2026-2030, the annual incidence of infections decreased to 7600 cases (no optimization), 2900 cases (optimization beginning in 2026), and 2200 cases (optimization beginning in 2023) in 2030. CONCLUSIONS Even without optimization, significant increases in resources could lead to an 80% decrease in the annual HIV incidence in 10 years. However, to reach both EHE targets, optimization of prevention funding early in the EHE period is necessary. Implementing these efficient allocations would require flexibility of funding across agencies, which might be difficult to achieve.
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Affiliation(s)
- Evin U. Jacobson
- Division of HIV/AIDS Prevention, Centers for Disease
Control and Prevention, Atlanta, GA
| | | | | | - David W. Purcell
- Division of HIV/AIDS Prevention, Centers for Disease
Control and Prevention, Atlanta, GA
| | - Timothy A Green
- Division of HIV/AIDS Prevention, Centers for Disease
Control and Prevention, Atlanta, GA
| | - Jonathan H. Mermin
- Division of HIV/AIDS Prevention, Centers for Disease
Control and Prevention, Atlanta, GA
| | - Paul G. Farnham
- Division of HIV/AIDS Prevention, Centers for Disease
Control and Prevention, Atlanta, GA
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Krebs E, Enns E, Zang X, Mah CS, Quan AM, Behrends CN, Coljin C, Goedel W, Golden M, Marshall BDL, Metsch LR, Pandya A, Shoptaw S, Sullivan P, Tookes HE, Duarte HA, Min JE, Nosyk B. Attributing health benefits to preventing HIV infections versus improving health outcomes among people living with HIV: an analysis in six US cities. AIDS 2021; 35:2169-2179. [PMID: 34148987 PMCID: PMC8490299 DOI: 10.1097/qad.0000000000002993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Combination strategies generate health benefits through improved health outcomes among people living with HIV (PLHIV) and prevention of new infections. We aimed to determine health benefits attributable to improved health among PLHIV versus HIV prevention for a set of combination strategies in six US cities. DESIGN A dynamic HIV transmission model. METHODS Using a model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City (NYC) and Seattle, we assessed the health benefits of city-specific optimal combinations of evidence-based interventions implemented at publicly documented levels and at ideal (90% coverage) scale-up (2020-2030 implementation, 20-year study period). We calculated the proportion of health benefit gains (measured as quality-adjusted life-years) resulting from averted and delayed HIV infections; improved health outcomes among PLHIV; and improved health outcomes due to medication for opioid use disorder (MOUD). RESULTS The HIV-specific proportion of total benefits ranged from 68.3% (95% credible interval: 55.3-80.0) in Seattle to 98.5% (97.5-99.3) in Miami, with the rest attributable to MOUD. The majority of HIV-specific health benefits in five of six cities were attributable HIV prevention, and ranged from 33.1% (26.1-41.1) in NYC to 83.1% (79.6-86.6) in Atlanta. Scaling up to ideal service levels resulted in three to seven-fold increases in additional health benefits, mostly from MOUD, with HIV-specific health gains primarily driven by HIV prevention. CONCLUSION Optimal combination strategies generated a larger proportion of health benefits attributable to HIV prevention in five of six cities, underlining the substantial benefits of antiretroviral therapy engagement for the prevention of HIV transmission through viral suppression. Understanding to whom benefits accrue may be important in assessing the equity and impact of HIV investments.
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Affiliation(s)
- Emanuel Krebs
- Faculty of Health Sciences, Simon Fraser University, Burnaby
- Health Economic Research Unit at the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Eva Enns
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Xiao Zang
- Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island, USA
| | - Cassandra S Mah
- Faculty of Health Sciences, Simon Fraser University, Burnaby
| | - Amanda M Quan
- Faculty of Health Sciences, Simon Fraser University, Burnaby
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, New York, USA
| | - Caroline Coljin
- Department of Mathematics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - William Goedel
- Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island, USA
| | - Matthew Golden
- Department of Medicine, Division of Allergy & Infectious Disease, University of Washington, Seattle, Washington
| | - Brandon D L Marshall
- Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, City, New York
| | - Ankur Pandya
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Steven Shoptaw
- Centre for HIV Identification, Prevention and Treatment Services, School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Hansel E Tookes
- Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Coral Gables, Florida
| | - Horacio A Duarte
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Jeong E Min
- Health Economic Research Unit at the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby
- Health Economic Research Unit at the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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Zang X, Krebs E, Chen S, Piske M, Armstrong WS, Behrends CN, Del Rio C, Feaster DJ, Marshall BDL, Mehta SH, Mermin J, Metsch LR, Schackman BR, Strathdee SA, Nosyk B. The Potential Epidemiological Impact of Coronavirus Disease 2019 (COVID-19) on the Human Immunodeficiency Virus (HIV) Epidemic and the Cost-effectiveness of Linked, Opt-out HIV Testing: A Modeling Study in 6 US Cities. Clin Infect Dis 2021; 72:e828-e834. [PMID: 33045723 PMCID: PMC7665350 DOI: 10.1093/cid/ciaa1547] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Background Widespread viral and serological testing for SARS-CoV-2 may present a unique opportunity to also test for HIV infection. We estimated the potential impact of adding linked, opt-out HIV testing alongside SARS-CoV-2 testing on HIV incidence and the cost-effectiveness of this strategy in six US cities. Methods Using a previously-calibrated dynamic HIV transmission model, we constructed three sets of scenarios for each city: (1) sustained current levels of HIV-related treatment and prevention services (status quo); (2) temporary disruptions in health services and changes in sexual and injection risk behaviours at discrete levels between 0%-50%; and (3) linked HIV and SARS-CoV-2 testing offered to 10%-90% of the adult population in addition to scenario (2). We estimated cumulative HIV infections between 2020-2025 and incremental cost-effectiveness ratios of linked HIV testing over 20 years. Results In the absence of linked, opt-out HIV testing, we estimated a total of 16.5% decrease in HIV infections between 2020-2025 in the best-case scenario (50% reduction in risk behaviours and no service disruptions), and 9.0% increase in the worst-case scenario (no behavioural change and 50% reduction in service access). We estimated that HIV testing (offered at 10%-90% levels) could avert a total of 576-7,225 (1.6%-17.2%) new infections. The intervention would require an initial investment of $20.6M-$220.7M across cities; however, the intervention would ultimately result in savings in health care costs in each city. Conclusions A campaign in which HIV testing is linked with SARS-CoV-2 testing could substantially reduce HIV incidence and reduce direct and indirect health care costs attributable to HIV.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Emanuel Krebs
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Siyuan Chen
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Micah Piske
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Czarina N Behrends
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Mermin
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | | | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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