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Cost-Effectiveness of HIV Retention and Re-engagement Interventions in High-Income Countries: A Systematic Literature Review

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Abstract

Engagement in lifelong HIV care is critical for both patient and public health, yet there are limited resources to invest in improving HIV outcomes. We systematically reviewed evidence on the cost-effectiveness of retention and re-engagement interventions. We searched five databases for peer-reviewed studies published between 2010 and 2020. We assessed reporting and methods quality, extracted data on target populations, interventions, and cost-effectiveness, and evaluated overall strength of evidence. Eleven studies met inclusion criteria, and eight had moderate-high quality. Cost-effectiveness estimates ranged from cost-saving to over $1,000,000/quality-adjusted life year (QALY) gained. Of the 73 cost-effectiveness ratios reported, 64% were < $100,000/QALY gained. Interventions were more likely to be cost-effective when targeted to high-risk groups, implemented in locations where baseline retention levels were low, and when used in combination with other high-impact HIV interventions (such as prevention). Overall, existing evidence is moderately strong that retention and/or re-engagement interventions can be cost-effective in high-income countries.

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Acknowledgements

The authors thank Shanda Hunt, a public health librarian who provided guidance on systematic literature searches and the construction of search terms. [Contact: hunt0081@umn.edu]

Funding

Dr. Enns was supported in part by a grant from the National Institute of Allergy and Infectious Disease of the National Institutes of Health (R01 AI138783). The remaining authors received no funding for this work.

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Authors and Affiliations

  1. Division of Health Policy and Management, University of Minnesota, 420 Delaware St. SE, MMC 729 Mayo, Minneapolis, MN, 55455, USA

    Margo M. Wheatley, Gregory S. Knowlton, Mary Butler & Eva A. Enns

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  1. Margo M. Wheatley
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  2. Gregory S. Knowlton
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  4. Eva A. Enns
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Contributions

MMW and MB contributed to the study conception and design. MMW and GSK performed the literature search and data analysis. MB and EAE advised on data analysis and methods. The first draft of the manuscript was written by Margo Wheatley and all authors critically revised, read, and approved the final manuscript.

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Correspondence to Eva A. Enns.

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Wheatley, M.M., Knowlton, G.S., Butler, M. et al. Cost-Effectiveness of HIV Retention and Re-engagement Interventions in High-Income Countries: A Systematic Literature Review. AIDS Behav 26, 2159–2168 (2022). https://doi.org/10.1007/s10461-021-03561-w

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