AIDS and Behavior

, Volume 22, Issue 11, pp 3734–3741 | Cite as

Cost–Utility of Access to Care, a National HIV Linkage, Re-engagement and Retention in Care Program

  • Catherine MaulsbyEmail author
  • Kriti M. Jain
  • Brian W. Weir
  • Blessing Enobun
  • Melissa Werner
  • Morey Riordan
  • David R. Holtgrave
  • A2C Intervention Team
Original Paper


Linkage to HIV medical care and on-going engagement in HIV medical care are vital for ending the HIV epidemic. However, little is known about the cost–utility of HIV linkage, re-engagement and retention (LRC) in care programs. This paper presents the cost–utility analysis of Access to Care, a national HIV LRC program. Using standard methods from the US Panel on Cost-Effectiveness in Health and Medicine, we calculated the cost–utility ratio. Seven Access to Care programs were cost-effective and two were cost-saving. This study adds to a small but growing body of evidence to support the cost-effectiveness of LRC programs.


Retention in HIV care Cost–utility HIV Access to Care 



The authors would like to express their gratitude to the A2C intervention staff for their dedication and for the individuals who participated in the A2C intervention. This document is based upon work under Grant No. 10SIHDC001 and supported by the Social Innovation Fund (SIF), a Program of the Corporation for National and Community Service (CNCS). Opinions or points of view expressed in this document are those of the authors and do not necessarily reflect the official position of, or a position that is endorsed by, CNCS or the Social Innovation Fund Program. The Social Innovation Fund is a Program of the Corporation for National and Community Service, a federal agency that engages millions of Americans in service through its AmeriCorps, Senior Corps, Social Innovation Fund, and Volunteer Generation Fund programs, and leads the President’s national call to service initiative, United We Serve. For more information, visit

Compliance with Ethical Standards

Conflict of interest

Catherine Maulsby, Kriti Jain, Brian Weir, Blessing Enobun, Melissa Werner, Morey Riordan, The Access to Care Intervention Team, and David Holtgrave have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Program sites underwent IRB approval locally. Program evaluation activities by Action Wellness, The Damien Center, and Amida Care were found to be non-human subjects research and consent was not obtained. Activities conducted by AIDS Action Committee were found to be minimal risk and all participants provided signed informed consent. Activities by AIDS Foundation of Chicago, AIDS Project Los Angeles, Christies Place, Louisiana Public Health Institute, Medical Advocacy and Outreach, and St. Louis Effort for AIDS were found to be participating in human subjects research which required IRB oversight. At all these sites written informed consent was obtained, except for St. Louis Effort for AIDS were informed consent was waved because all data were de-identified. JHU’s IRB found the cost evaluation to be non-human subjects research and informed consent was not obtained.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Catherine Maulsby
    • 1
    Email author
  • Kriti M. Jain
    • 1
  • Brian W. Weir
    • 1
  • Blessing Enobun
    • 1
  • Melissa Werner
    • 2
  • Morey Riordan
    • 2
  • David R. Holtgrave
    • 1
  • A2C Intervention Team
  1. 1.Department of Health Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.AIDS UnitedWashingtonUSA

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