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HIV Treatment and Prevention

Author

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  • Jessie L. Juusola
  • Margaret L. Brandeau

Abstract

Objective. To create a simple model to help public health decision makers determine how to best invest limited resources in HIV treatment scale-up and prevention. Method. A linear model was developed for determining the optimal mix of investment in HIV treatment and prevention, given a fixed budget. The model incorporates estimates of secondary health benefits accruing from HIV treatment and prevention and allows for diseconomies of scale in program costs and subadditive benefits from concurrent program implementation. Data sources were published literature. The target population was individuals infected with HIV or at risk of acquiring it. Illustrative examples of interventions include preexposure prophylaxis (PrEP), community-based education (CBE), and antiretroviral therapy (ART) for men who have sex with men (MSM) in the US. Outcome measures were incremental cost, quality-adjusted life-years gained, and HIV infections averted. Results. Base case analysis indicated that it is optimal to invest in ART before PrEP and to invest in CBE before scaling up ART. Diseconomies of scale reduced the optimal investment level. Subadditivity of benefits did not affect the optimal allocation for relatively low implementation levels. The sensitivity analysis indicated that investment in ART before PrEP was optimal in all scenarios tested. Investment in ART before CBE became optimal when CBE reduced risky behavior by 4% or less. Limitations of the study are that dynamic effects are approximated with a static model. Conclusions. Our model provides a simple yet accurate means of determining optimal investment in HIV prevention and treatment. For MSM in the US, HIV control funds should be prioritized on inexpensive, effective programs like CBE, then on ART scale-up, with only minimal investment in PrEP.

Suggested Citation

  • Jessie L. Juusola & Margaret L. Brandeau, 2016. "HIV Treatment and Prevention," Medical Decision Making, , vol. 36(3), pages 391-409, April.
    • Handle: RePEc:sae:medema:v:36:y:2016:i:3:p:391-409
    DOI: 10.1177/0272989X15598528
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    References listed on IDEAS

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    1. Arielle Lasry & Stephanie Sansom & Katherine Hicks & Vladislav Uzunangelov, 2011. "A model for allocating CDC’s HIV prevention resources in the United States," Health Care Management Science, Springer, vol. 14(1), pages 115-124, March.
    2. Stephanie Earnshaw & Katherine Hicks & Anke Richter & Amanda Honeycutt, 2007. "A linear programming model for allocating HIV prevention funds with state agencies: a pilot study," Health Care Management Science, Springer, vol. 10(3), pages 239-252, September.
    3. José L Burgos & Julia A Gaebler & Steffanie A Strathdee & Remedios Lozada & Hugo Staines & Thomas L Patterson, 2010. "Cost-Effectiveness of an Intervention to Reduce HIV/STI Incidence and Promote Condom Use among Female Sex Workers in the Mexico–US Border Region," PLOS ONE, Public Library of Science, vol. 5(6), pages 1-10, June.
    4. Sabina S. Alistar & Margaret L. Brandeau & Eduard J. Beck, 2013. "REACH: A Practical HIV Resource Allocation Tool for Decision Makers," International Series in Operations Research & Management Science, in: Gregory S. Zaric (ed.), Operations Research and Health Care Policy, edition 127, chapter 0, pages 201-223, Springer.
    5. Sabina S Alistar & Douglas K Owens & Margaret L Brandeau, 2014. "Effectiveness and Cost Effectiveness of Oral Pre-Exposure Prophylaxis in a Portfolio of Prevention Programs for Injection Drug Users in Mixed HIV Epidemics," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-11, January.
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    Cited by:

    1. Lauren E. Cipriano & Thomas A. Weber, 2018. "Population-level intervention and information collection in dynamic healthcare policy," Health Care Management Science, Springer, vol. 21(4), pages 604-631, December.

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