TY - JOUR
T1 - Ending the HIV epidemic in the USA
T2 - an economic modelling study in six cities
AU - Localized HIV Modeling Study Group
AU - Nosyk, Bohdan
AU - Zang, Xiao
AU - Krebs, Emanuel
AU - Enns, Benjamin
AU - Min, Jeong E.
AU - Behrends, Czarina N.
AU - del Rio, Carlos
AU - Dombrowski, Julia C.
AU - Feaster, Daniel J.
AU - Golden, Matthew
AU - Marshall, Brandon D.L.
AU - Mehta, Shruti H.
AU - Metsch, Lisa R.
AU - Pandya, Ankur
AU - Schackman, Bruce R.
AU - Shoptaw, Steven
AU - Strathdee, Steffanie A.
AU - Gebo, Kelly A.
AU - Kirk, Gregory
AU - Montaner, Julio
N1 - Funding Information:
This study was funded by the National Institute on Drug Abuse (NIDA grant number R01DA041747) of the National Institutes of Health (NIH; Bethesda, MD, USA). BRS received additional support from the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV, funded by NIDA ( grant number P30DA040500 ). SS is supported by the University of California Los Angeles Center for HIV Identification, Prevention and Treatment Services (Los Angeles, CA, USA), funded by the NIH ( grant number P30 MH058107 ). SAS is supported by a NIDA Method to Extend Research in Time award ( R37DA019829 ).
Funding Information:
This study was funded by the National Institute on Drug Abuse (NIDA grant number R01DA041747) of the National Institutes of Health (NIH; Bethesda, MD, USA). BRS received additional support from the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV, funded by NIDA (grant number P30DA040500). SS is supported by the University of California Los Angeles Center for HIV Identification, Prevention and Treatment Services (Los Angeles, CA, USA), funded by the NIH (grant number P30 MH058107). SAS is supported by a NIDA Method to Extend Research in Time award (R37DA019829).
Funding Information:
CNB reports grants from the US National Institute on Drug Abuse (NIDA), during the conduct of the study. CdR reports grants from the US National Insitutes of Health (NIH; NIDA and the National Institute of Allergy and Infectious Diseases), during the conduct of the study. JCD and MG report grants to the University of Washington from Hologic outside of the submitted work. BDLM reports grants from Simon Fraser University, during the conduct of the study; and grants from NIH, outside the submitted work. SHM reports personal fees from Gilead Sciences, outside the submitted work. BRS reports grants from NIDA, during the conduct of the study. SS reports grants from the US National Institute of Mental Health Center for HIV Identification Prevention and Treatment Services, outside the submitted work. All other authors declare no competing interests.
Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/7
Y1 - 2020/7
N2 - Background: The HIV epidemic in the USA is a collection of diverse local microepidemics. We aimed to identify optimal combination implementation strategies of evidence-based interventions to reach 90% reduction of incidence in 10 years, in six US cities that comprise 24·1% of people living with HIV in the USA. Methods: In this economic modelling study, we used a dynamic HIV transmission model calibrated with the best available evidence on epidemiological and structural conditions for six US cities: Atlanta (GA), Baltimore (MD), Los Angeles (CA), Miami (FL), New York City (NY), and Seattle (WA). We assessed 23 040 combinations of 16 evidence-based interventions (ie, HIV prevention, testing, treatment, engagement, and re-engagement) to identify combination strategies providing the greatest health benefit while remaining cost-effective. Main outcomes included averted HIV infections, quality-adjusted life-years (QALYs), total cost (in 2018 US$), and incremental cost-effectiveness ratio (ICER; from the health-care sector perspective, 3% annual discount rate). Interventions were implemented at previously documented and ideal (90% coverage or adoption) scale-up, and sustained from 2020 to 2030, with outcomes evaluated until 2040. Findings: Optimal combination strategies providing health benefit and cost-effectiveness contained between nine (Seattle) and 13 (Miami) individual interventions. If implemented at previously documented scale-up, these strategies could reduce incidence by between 30·7% (95% credible interval 19·1–43·7; Seattle) and 50·1% (41·5–58·0; New York City) by 2030, at ICERs ranging from cost-saving in Atlanta, Baltimore, and Miami, to $95 416 per QALY in Seattle. Incidence reductions reached between 39·5% (26·3–53·8) in Seattle and 83·6% (70·8–87·0) in Baltimore at ideal implementation. Total costs of implementing strategies across the cities at previously documented scale-up reached $559 million per year in 2024; however, costs were offset by long-term reductions in new infections and delayed disease progression, with Atlanta, Baltimore, and Miami projecting cost savings over the 20 year study period. Interpretation: Evidence-based interventions can deliver substantial public health and economic value; however, complementary strategies to overcome social and structural barriers to HIV care will be required to reach national targets of the ending the HIV epidemic initiative by 2030. Funding: National Institutes of Health.
AB - Background: The HIV epidemic in the USA is a collection of diverse local microepidemics. We aimed to identify optimal combination implementation strategies of evidence-based interventions to reach 90% reduction of incidence in 10 years, in six US cities that comprise 24·1% of people living with HIV in the USA. Methods: In this economic modelling study, we used a dynamic HIV transmission model calibrated with the best available evidence on epidemiological and structural conditions for six US cities: Atlanta (GA), Baltimore (MD), Los Angeles (CA), Miami (FL), New York City (NY), and Seattle (WA). We assessed 23 040 combinations of 16 evidence-based interventions (ie, HIV prevention, testing, treatment, engagement, and re-engagement) to identify combination strategies providing the greatest health benefit while remaining cost-effective. Main outcomes included averted HIV infections, quality-adjusted life-years (QALYs), total cost (in 2018 US$), and incremental cost-effectiveness ratio (ICER; from the health-care sector perspective, 3% annual discount rate). Interventions were implemented at previously documented and ideal (90% coverage or adoption) scale-up, and sustained from 2020 to 2030, with outcomes evaluated until 2040. Findings: Optimal combination strategies providing health benefit and cost-effectiveness contained between nine (Seattle) and 13 (Miami) individual interventions. If implemented at previously documented scale-up, these strategies could reduce incidence by between 30·7% (95% credible interval 19·1–43·7; Seattle) and 50·1% (41·5–58·0; New York City) by 2030, at ICERs ranging from cost-saving in Atlanta, Baltimore, and Miami, to $95 416 per QALY in Seattle. Incidence reductions reached between 39·5% (26·3–53·8) in Seattle and 83·6% (70·8–87·0) in Baltimore at ideal implementation. Total costs of implementing strategies across the cities at previously documented scale-up reached $559 million per year in 2024; however, costs were offset by long-term reductions in new infections and delayed disease progression, with Atlanta, Baltimore, and Miami projecting cost savings over the 20 year study period. Interpretation: Evidence-based interventions can deliver substantial public health and economic value; however, complementary strategies to overcome social and structural barriers to HIV care will be required to reach national targets of the ending the HIV epidemic initiative by 2030. Funding: National Institutes of Health.
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U2 - 10.1016/S2352-3018(20)30033-3
DO - 10.1016/S2352-3018(20)30033-3
M3 - Article
C2 - 32145760
AN - SCOPUS:85082516833
VL - 7
SP - e491-e503
JO - The Lancet HIV
JF - The Lancet HIV
SN - 2352-3018
IS - 7
ER -