TY - JOUR
T1 - Attributing health benefits to preventing HIV infections versus improving health outcomes among people living with HIV
T2 - An analysis in six US cities
AU - Localized HIV Economic Modeling Study Group
AU - Krebs, Emanuel
AU - Enns, Eva
AU - Zang, Xiao
AU - Mah, Cassandra S.
AU - Quan, Amanda M.
AU - Behrends, Czarina N.
AU - Coljin, Caroline
AU - Goedel, William
AU - Golden, Matthew
AU - Marshall, Brandon D.L.
AU - Metsch, Lisa R.
AU - Pandya, Ankur
AU - Shoptaw, Steven
AU - Sullivan, Patrick
AU - Tookes, Hansel E.
AU - Duarte, Horacio A.
AU - Min, Jeong E.
AU - Nosyk, Bohdan
N1 - Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - 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.
AB - 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.
KW - HIV
KW - HIV prevention
KW - HIV treatment
KW - dynamic HIV transmission model
KW - health benefits
KW - localized HIV microepidemics
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U2 - 10.1097/QAD.0000000000002993
DO - 10.1097/QAD.0000000000002993
M3 - Article
C2 - 34148987
AN - SCOPUS:85118096137
SN - 0269-9370
VL - 35
SP - 2169
EP - 2179
JO - AIDS
JF - AIDS
IS - 13
ER -
