The cost and intensity of behavioral interventions to promote HIV treatment for prevention among HIV-positive men who have sex with men.
The cost and intensity of behavioral interventions to promote HIV treatment for prevention among HIV-positive men who have sex with men.
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DOI：
10.1007/s10508-014-0455-3
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发表时间：
2015-10
影响因子：
3.8
通讯作者：
Mayer KH
中科院分区：
文献类型：
--
作者：
Safren SA;Perry NS;Blashill AJ;O'Cleirigh C;Mayer KH
最近，艾滋病毒的行为预防干预措施被批评为无效，昂贵或效率低下。在这篇评论中，使用艾滋病毒阳性的男男性行为者（MSM）作为说明性的高风险人群，我们认为，相反的是正确的-艾滋病毒预防的行为干预，如果与需要他们的人群实施，是负担得起的，对未来的预防工作至关重要。我们的论点基于最近的证据，表明1）坚持抗逆转录病毒治疗（ART）用于预防目的是必要的，以抑制艾滋病毒复制和减少传播，2）艾滋病毒感染者有多种心理社会问题，影响自我护理和适度的健康行为干预的潜在有效性，同时针对这两个问题（社会心理和艾滋病毒护理）的强化干预措施可以显示出临床上的显著改善。我们随后通过比较这些类型的干预措施的成本与标准的艾滋病毒临床治疗与ART的成本，并证明了潜在的密集行为干预措施的成本节约，在这种情况下，艾滋病毒阳性的男男性行为者有不受控制的病毒。考虑到这一证据，我们得出结论，个人干预必须仍然是艾滋病毒预防某些关键人群的支柱。
Recently, behavioral prevention interventions for HIV have been criticized as being ineffective, costly, or inefficient. In this commentary, using HIV-positive men who have sex with men (MSM) as an illustrative high-risk population, we argue that the opposite is true – that behavioral interventions for HIV prevention, if implemented with the populations who need them, are affordable and critical for future prevention efforts. We base this argument on recent evidence showing that 1) adherence to antiretroviral treatment (ART) for prevention purposes is necessary to suppress HIV replication and reduce transmissibility, 2) individuals living with HIV have multiple psychosocial concerns that impact self-care and moderate the potential effectiveness of health behavior interventions, and 3) intensive interventions targeting both concerns together (psychosocial and HIV care) can show clinically significant improvement. We follow by comparing the cost of these types of interventions to the cost of standard clinical treatment for HIV with ART, and demonstrate a cost-savings of potential intensive behavioral interventions for, in this case, HIV-positive MSM who have uncontrolled virus. Keeping this evidence in mind, we conclude that individual intervention must remain a mainstay of HIV prevention for certain critical populations.