The cost-effectiveness of specific measures to prevent or treat HIV varies between U.S. cities, leading to a different mix of optimal interventions depending on the local microepidemic, a modeling study published in AIDS found.
Comparing various types of evidence-based interventions (including programs to prevent HIV, increase testing, and improve engagement or re-engagement in HIV treatment) across six U.S. cities, researchers projected a maximum 10% reduction in HIV incidence rates if only a single measure is used. The cost of different scale-up scenarios was expressed as money spent to gain one quality-adjusted life-year (QALY), a common metric for evaluating public health efforts. More HIV testing was cost-effective or even saved money across all locations. Other interventions did not yield benefits across the board: Targeted pre-exposure prophylaxis (PrEP) for men who have sex with men, for example, only made financial sense in four of the six cities.
Local differences in care access were also reflected in these calculations. For example, increasing HIV treatment engagement in Atlanta, Georgia, with its lack of Medicaid expansion, yielded a relatively low value because of the disparity in treatment access, study authors explained.
The study also found that helping people with substance use disorder get medications for their illness had relatively little impact on HIV incidence, but was nonetheless cost-effective in reducing mortality in all cities studied.
Results show the need for combination strategies customized to local conditions, as well as the necessity of addressing issues that impede access to HIV care before the U.S.’s “Ending the HIV Epidemic” targets can be met, study authors concluded.