DEVELOPMENT OF A MATHEMATICAL MODEL TO ESTIMATE THE COST-EFFECTIVENESS OF THE RYAN WHITE HIV/AIDS PROGRAM

Thu, 22 Oct 2020 00:00:00 GMT-05:00 - Goyal, Ravi; Hu, Cindy; Klein, Pamela W.; Hotchkiss, John; Morris, Eric; Mandsager, Paul; Cohen, Stacy M.; Luca, Dara; Gao, Jessica; Jones, Andrew; Addison, West; O’Brien-Strain, Margaret; Cheever, Laura W.; Gilman, Boyd
Εισαγωγή: The Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program (RWHAP) provides services to more than half of all people with diagnosed HIV in the United States. We present and validate a mathematical model that can be used to estimate the long-term public health and cost impact of the federal program.
Μέθοδοι: We developed a stochastic, agent-based model that reflects the current HIV epidemic in the United States. The model simulates everyone's progression along the HIV care continuum, using two network-based mechanisms for HIV transmission: injection drug use and sexual contact. To test the validity of the model, we calculated HIV incidence, mortality, life expectancy, and lifetime care costs and compared the results with external benchmarks.
Αποτελέσματα: The estimated HIV incidence rate for men who have sex with men (502 per 100,000 person years), mortality rate of all people with diagnosed HIV (1,663 per 100,000 person years), average life expectancy for individuals with low CD4 counts not on antiretroviral therapy (1.52–3.78 years), and lifetime costs ($362,385) all met our validity criterion of within 15 percent of external benchmarks.
Συμπεράσματα: The model represents a complex HIV care delivery system rather than a single intervention, which required developing solutions to several challenges, such as calculating need for and receipt of multiple services and estimating their impact on care retention and viral suppression. Our strategies to address these methodological challenges produced a valid model for assessing the cost-effectiveness of the RWHAP. Corresponding Author: Boyd Gilman, PhD, Mathematica, Inc. 955 Massachusetts Ave., 801, Cambridge, MA 02138, Email: BGilman@mathematica-mpr.com, Phone: 617-301-8974 Funding Source: This study was funded by the Health Resources and Services Administration contract # HHSH250201300018I. The authors report no conflicts of interest related to this work. - Β© 2020

Embedding a Linkage to Pre-Exposure Prophylaxis (PrEP) Care Intervention in Social Network Strategy and Partner Notification Services: Results from a Pilot Randomized Controlled Trial

Thu, 22 Oct 2020 00:00:00 GMT-05:00 - Teixeira da Silva, Daniel; Bouris, Alida; Ramachandran, Arthi; Blocker, Olivia; Davis, Billy; Harris, James; Pyra, Maria; Rusie, Laura K.; Brewer, Russell; Pagkas-Bather, Jade; Hotton, Anna; Ridgway, Jessica P.; McNulty, Moira; Bhatia, Ramona; Schneider, John A.
Εισαγωγή: Increased pre-exposure prophylaxis (PrEP) uptake among Black men who have sex with men and Black transgender women (BMSM/TW) is needed to end the HIV epidemic. Embedding a brief intervention in network services that engage individuals in HIV transmission networks for HIV/STI testing may be an important strategy to accelerate PrEP uptake. Setting: Partner Services PrEP (PS-PrEP) study is a pilot randomized control trial to improve linkage to PrEP care among BMSM/TW presenting for network services in Chicago, IL from 2015 to 2017.
Μέθοδοι: BMSM/TW (N=146) aged 18-40 were recruited from network services (partners services and social network strategy services). Intervention participants developed an individualized linkage plan based on the Information-Motivation-Behavioral Skills model and received mini-booster sessions. Control participants received treatment as usual. Socio-demographic, behavioral, and clinical factors were examined at baseline, three- and 12-months post-intervention. Intent-to-treat analyses examined linkage to PrEP care within three months post-intervention (primary outcome). Secondary outcomes were PrEP initiation, time to linkage to PrEP care, and time to PrEP initiation.
Αποτελέσματα: Compared to control participants, a significantly greater proportion of the intervention participants were linked to PrEP care within three months (24% vs. 11%; p=0.04) and initiated PrEP (24% vs. 11%, p=0.05). Among those linked to PrEP care within the study period, intervention participants were linked significantly sooner than control participants (median [interquartile range] days, 26.5 [6.0, 141.8] vs. 191.5 [21.5, 297.0]; p=0.05).
Συμπέρασμα: Study results support the preliminary efficacy of PS-PrEP to improve linkage to PrEP care and PrEP initiation among BMSM/TW. (word count/word limit = 248/250) Corresponding author: John A Schneider, Departments of Medicine and Public Health Sciences, University of Chicago, 5837 South Maryland Avenue, MC 5065, Chicago, IL 60637, Phone: 773.702.2453 Fax: 773.702.1979, Email:jschnei1@medicine.bsd.uchicago.edu (preferred) Author conflicts of interest: none Funding: This study was funded by the National Institute of Mental Health (1R34MH104058-01). ClinicalTrials.gov Identifier: NCT02749955. - Β© 2020