Attributing health benefits to preventing HIV infections versus improving health outcomes among people living with HIV: an analysis in six US cities.
Attributing health benefits to preventing HIV infections versus improving health outcomes among people living with HIV: an analysis in six US cities.
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DOI：
10.1097/qad.0000000000002993
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发表时间：
2021-11-01
期刊：
影响因子：
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通讯作者：
on behalf of the Localized HIV Economic Modeling study group
中科院分区：
文献类型：
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作者：
Krebs E;Enns E;Zang X;Mah CS;Quan AM;Behrends CN;Coljin C;Goedel W;Golden M;Marshall BDL;Metsch LR;Pandya A;Shoptaw S;Sullivan P;Tookes HE;Duarte HA;Min JE;Nosyk B;on behalf of the Localized HIV Economic Modeling study group
组合战略通过改善艾滋病毒携带者(PLHIV)的健康结果和预防新的感染而产生健康益处。我们的目标是确定在美国6个城市的一套组合策略中，PLHIV与HIV预防之间的健康改善可归因于健康益处。HIV动态传播模型。使用为亚特兰大、巴尔的摩、洛杉矶、迈阿密、纽约市(NYC)和西雅图校准的模型，我们评估了在公开记录的水平和理想(90%覆盖率)规模(2020-2030年实施，20年研究期)下实施的循证干预措施的特定城市最佳组合的健康益处。我们计算了因避免和延迟艾滋病毒感染而获得的健康收益(以质量调整的寿命年衡量)的比例；PLHIV中健康结果的改善；以及因阿片类药物使用障碍(MOUD)而改善的健康结果。在总受益中，艾滋病毒特有的比例从西雅图的68.3%(95%可信区间：55.3%-80.0%)到迈阿密的98.5%(97.5%-99.3%)不等，其余的归因于穆德。在六个城市中的五个城市，艾滋病毒特有的健康益处大多归因于艾滋病毒预防，范围从纽约市的33.1%(26.1%-41.1%)到亚特兰大的83.1%(79.6-86.6%)。扩大到理想的服务水平导致额外的健康福利增加三到七倍，主要来自Moud，艾滋病毒特有的健康收益主要由艾滋病毒预防推动。最佳组合战略在六个城市中的五个城市产生了可归因于艾滋病毒预防的更大比例的健康惠益，强调了参与抗逆转录病毒药物治疗对通过抑制病毒传播预防艾滋病毒传播的实质性好处。在评估艾滋病毒投资的公平性和影响时，了解受益对象可能很重要。
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 6 US cities. Dynamic HIV transmission model. 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). 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. Optimal combination strategies generated a larger proportion of health benefits attributable to HIV prevention in five of six cities, underlining the substantial benefits of ART 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.
DOI：
10.1016/j.jval.2020.06.013
发表时间：
2020-12
期刊：
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
影响因子：
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作者：
Zang X;Jalal H;Krebs E;Pandya A;Zhou H;Enns B;Nosyk B
通讯作者：
Nosyk B