Abstract
BackgroundNew York City (NYC) remains an epicenter of the HIV epidemic in the United States. Given the variety of evidence-based HIV prevention strategies available and the significant resources required to implement each of them, comparative studies are needed to identify how to maximize the number of HIV cases prevented most economically.MethodsA new model of HIV disease transmission was developed integrating information from a previously validated micro-simulation HIV disease progression model. Specification and parameterization of the model and its inputs, including the intervention portfolio, intervention effects and costs were conducted through a collaborative process between the academic modeling team and the NYC Department of Health and Mental Hygiene. The model projects the impact of different prevention strategies, or portfolios of prevention strategies, on the HIV epidemic in NYC.ResultsTen unique interventions were able to provide a prevention benefit at an annual program cost of less than $360,000, the threshold for consideration as a cost-saving intervention (because of offsets by future HIV treatment costs averted). An optimized portfolio of these specific interventions could result in up to a 34% reduction in new HIV infections over the next 20 years. The cost-per-infection averted of the portfolio was estimated to be $106,378; the total cost was in excess of $2 billion (over the 20 year period, or approximately $100 million per year, on average). The cost-savings of prevented infections was estimated at more than $5 billion (or approximately $250 million per year, on average).ConclusionsOptimal implementation of a portfolio of evidence-based interventions can have a substantial, favorable impact on the ongoing HIV epidemic in NYC and provide future cost-saving despite significant initial costs.
Highlights
New York City (NYC) remains an epicenter of HIV in the U.S More than 110,000 New Yorkers are living with HIV, and almost 3,500 new cases of HIV were diagnosed in 2010 [1]
RR: risk ratio; PEP: Post-exposure prophylaxis; STD: sexually transmitted disease; SBIRT: screening, brief intervention and referral for treatment for unhealthy alcohol use; IDU: injection drug use. 1Values of intervention effect sizes represent relative risk benefits on pathway applied to prioritized population(s) except where noted
The proportions of new infections among different risk categories (MSM, heterosexuals and IDUs) and the overall prevalence predicted by the simulation during the first year closely resembled the relevant 2009 NYC data (Figure 2)
Summary
New York City (NYC) remains an epicenter of HIV in the U.S More than 110,000 New Yorkers are living with HIV, and almost 3,500 new cases of HIV were diagnosed in 2010 [1]. Some investigators have theorized that the HIV epidemic can even be extinguished in certain settings with systematic prioritization and implementation of a package of aggressive interventions (e.g., universal annual testing, prompt linkage to care, and immediate antiretroviral therapy [ART] initiation) [4]. These interventions require substantial resources, and it remains unclear how to best allocate HIV prevention resources to maximize the number of new HIV cases prevented. New York City (NYC) remains an epicenter of the HIV epidemic in the United States. Given the variety of evidence-based HIV prevention strategies available and the significant resources required to implement each of them, comparative studies are needed to identify how to maximize the number of HIV cases prevented most economically
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