Cost-Effectiveness of HIV Retention and Re-engagement Interventions in High-Income Countries: A Systematic Literature Review

Margo M Wheatley, Gregory S. Knowlton, Mary E Butler, Eva A. Enns

Research output: Contribution to journalReview articlepeer-review


Engagement in lifelong HIV care is critical for both patient and public health, yet there are limited resources to invest in improving HIV outcomes. We systematically reviewed evidence on the cost-effectiveness of retention and re-engagement interventions. We searched five databases for peer-reviewed studies published between 2010 and 2020. We assessed reporting and methods quality, extracted data on target populations, interventions, and cost-effectiveness, and evaluated overall strength of evidence. Eleven studies met inclusion criteria, and eight had moderate-high quality. Cost-effectiveness estimates ranged from cost-saving to over $1,000,000/quality-adjusted life year (QALY) gained. Of the 73 cost-effectiveness ratios reported, 64% were < $100,000/QALY gained. Interventions were more likely to be cost-effective when targeted to high-risk groups, implemented in locations where baseline retention levels were low, and when used in combination with other high-impact HIV interventions (such as prevention). Overall, existing evidence is moderately strong that retention and/or re-engagement interventions can be cost-effective in high-income countries.

Original languageEnglish (US)
Pages (from-to)2159-2168
Number of pages10
JournalAIDS and Behavior
Issue number7
StateAccepted/In press - 2022

Bibliographical note

Funding Information:
Dr. Enns was supported in part by a grant from the National Institute of Allergy and Infectious Disease of the National Institutes of Health (R01 AI138783). The remaining authors received no funding for this work.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.


  • Care continuum
  • Cost-effectiveness
  • Engagement
  • Retention


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