Abstract
AimsTwo behavioral HIV prevention interventions for people who inject drugs (PWID) infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+), a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+) Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST), to the status quo in the U.S.MethodsA dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs) gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy.ResultsOver 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY), and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone.ConclusionsBoth behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+.
Highlights
Despite numerous evidence-based HIV prevention interventions, HIV incidence in the U.S has remained unchanged over the past 15 years, with approximately 50,000 new infections occurring annually [1]
Two-thirds of infections averted with either program are among non-People who inject drugs (PWID), due to reduced sexual transmission from PWID to their partners
The interventions targeted PWID only, this substantial benefit accrued to the general population because of reductions in risky sexual behavior by PWID, and due to reduced secondary transmission
Summary
Despite numerous evidence-based HIV prevention interventions, HIV incidence in the U.S has remained unchanged over the past 15 years, with approximately 50,000 new infections occurring annually [1]. PWID engage in increased injection-related and sexual risk behaviors that can transmit HIV to others, fueling HIV transmission to the general population [3]. Increased access to combination antiretroviral therapy (ART) markedly reduces HIV-related morbidity and mortality. Consistent ART access and optimal adherence suppresses viral replication, conferring benefits to uninfected populations by reducing sexual HIV transmission [4,5]. Given concerns that the benefits of expanded ART might be offset by risk behavior disinhibition and the corresponding increase in sexually transmitted infections (STIs) that facilitate transmission, the role of evidence-based interventions (EBIs) for high-risk populations as part of a comprehensive HIV prevention and treatment approach has become exceedingly important [9]
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