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Ending the HIV Epidemic Among Persons Who Inject Drugs: A Cost-Effectiveness Analysis in Six US Cities.

  • Author(s): Krebs, Emanuel;
  • Zang, Xiao;
  • Enns, Benjamin;
  • Min, Jeong E;
  • Behrends, Czarina N;
  • Del Rio, Carlos;
  • Dombrowski, Julia C;
  • Feaster, Daniel J;
  • Gebo, Kelly A;
  • Marshall, Brandon DL;
  • Mehta, Shruti H;
  • Metsch, Lisa R;
  • Pandya, Ankur;
  • Schackman, Bruce R;
  • Strathdee, Steffanie A;
  • Nosyk, Bohdan;
  • Localized HIV Modeling Study Group
  • et al.
Abstract

Background

Persons who inject drugs (PWID) are at a disproportionately high risk of HIV infection. We aimed to determine the highest-valued combination implementation strategies to reduce the burden of HIV among PWID in 6 US cities.

Methods

Using a dynamic HIV transmission model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City, and Seattle, we assessed the value of implementing combinations of evidence-based interventions at optimistic (drawn from best available evidence) or ideal (90% coverage) scale-up. We estimated reduction in HIV incidence among PWID, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for each city (10-year implementation; 20-year horizon; 2018 $ US).

Results

Combinations that maximized health benefits contained between 6 (Atlanta and Seattle) and 12 (Miami) interventions with ICER values ranging from $94 069/QALY in Los Angeles to $146 256/QALY in Miami. These strategies reduced HIV incidence by 8.1% (credible interval [CI], 2.8%-13.2%) in Seattle and 54.4% (CI, 37.6%-73.9%) in Miami. Incidence reduction reached 16.1%-75.5% at ideal scale.

Conclusions

Evidence-based interventions targeted to PWID can deliver considerable value; however, ending the HIV epidemic among PWID will require innovative implementation strategies and supporting programs to reduce social and structural barriers to care.

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