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J Infect Dis. 2017 Oct 17;216(7):798-807. doi: 10.1093/infdis/jix349.

The Clinical and Economic Impact of Attaining National HIV/AIDS Strategy Treatment Targets in the United States.

Author information

1
Medical Practice Evaluation Center.
2
Division of General Internal Medicine.
3
Division of Infectious Diseases.
4
Yale School of Public Health, New Haven, Connecticut.
5
Department of Pediatrics, Massachusetts General Hospital.
6
Division of Infectious Diseases, Brigham and Women's Hospital.
7
Harvard University Center for AIDS Research, Harvard Medical School.
8
Department of Epidemiology, Boston University School of Public Health.
9
Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.

Abstract

Background:

The US National HIV/AIDS Strategy (NHAS) aims for 72% (90% diagnosed times 80% of those virally suppressed) viral suppression among persons with human immunodeficiency virus (HIV) by 2020. We examined the clinical and economic impact of reaching this target, in the general US population and among black men who have sex with men (MSM), the group with the highest HIV prevalence.

Methods:

Using a mathematical simulation, we project the 5- and 20-year clinical outcomes, costs, and incremental cost-effectiveness ratios for (1) Current Pace of detection, linkage, retention, and virologic suppression and (2) NHAS investments in expanded testing ($24-$74 per test) and adherence ($400 per person-year), calibrated to achieve 72% suppression by 2020. We examined alternative rates of testing, retention, and suppression and the efficacy and cost of adherence interventions.

Results:

Compared with Current Pace over 20 years, NHAS averted 280000 HIV transmissions (80000 in black MSM) and 199000 (45000) deaths and saved 2138000 (453000) years of life, while increasing costs by 23%. The incremental cost-effectiveness ratio for NHAS compared with Current Pace was $68900 per quality-adjusted life-year ($38300 for black MSM) and was most sensitive to antiretroviral therapy costs.

Conclusions:

Reaching NHAS targets would yield substantial clinical benefits and be cost-effective in both the general US and black MSM populations.

KEYWORDS:

HIV; HIV treatment scale-up; National HIV/AIDS Strategy; treatment cascade

PMID:
29029344
PMCID:
PMC5853503
DOI:
10.1093/infdis/jix349
[Indexed for MEDLINE]
Free PMC Article

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