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

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Abstract

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.

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References

  1. Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57(8):1164–71. https://doi.org/10.1093/cid/cit420.

    Article  Google Scholar 

  2. White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States. Washington, DC: The White House; 2010. http://www.whitehouse.gov/administration/eop/onap/nhas. Accessed 27 Feb 2016.

  3. White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States: updated to 2020. Washington, DC: The White House; 2015. https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf. Accessed 27 Feb 2016.

  4. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800. https://doi.org/10.1093/cid/ciq243.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hall HI, Frazier EL, Rhodes P, Holtgrave DR, Furlow-Parmley C, Tang T, et al. Differences in human immunodeficiency virus care and treatment among subpopulations in the United States. JAMA Intern Med. 2013;173(14):1337–44. https://doi.org/10.1001/jamainternmed.2013.6841.

    Article  PubMed  Google Scholar 

  6. Higa DH, Crepaz N, Mullins MM, Prevention Research Synthesis Project. Identifying best practices for increasing linkage to, retention, and re-engagement in HIV medical care: findings from a systematic review, 1996–2014. AIDS Behav. 2016;20(5):951–66. https://doi.org/10.1007/s10461-015-1204-x.

    Article  Google Scholar 

  7. Liau A, Crepaz N, Lyles CM, Higa DH, Mullins MM, DeLuca J, et al. Interventions to promote linkage to and utilization of HIV medical care among HIV-diagnosed persons: a qualitative systematic review, 1996–2011. AIDS Behav. 2013;17(6):1941–62. https://doi.org/10.1007/s10461-013-0435-y.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gopalappa C, Farnham PG, Hutchinson AB, Sansom SL. Cost effectiveness of the National HIV/AIDS Strategy goal of increasing linkage to care for HIV-infected persons. J Acquir Immune Defic Syndr. 2012;61(1):99–105. https://doi.org/10.1097/qai.0b013e31825bd862.

    Article  PubMed  Google Scholar 

  9. Nosyk B, Min JE, Lima VD, Hogg RS, Montaner JS, Group SHAs. Cost-effectiveness of population-level expansion of highly active antiretroviral treatment for HIV in British Columbia, Canada: a modelling study. Lancet HIV. 2015;2(9):e393–400. https://doi.org/10.1016/s2352-3018(15)00127-7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shah M, Risher K, Berry SA, Dowdy DW. The epidemiologic and economic impact of improving HIV testing, linkage, and retention in care in the United States. Clin Infect Dis. 2016;62(2):220–9. https://doi.org/10.1093/cid/civ801.

    Article  PubMed  Google Scholar 

  11. Zhang L, Phanuphak N, Henderson K, Nonenoy S, Srikaew S, Shattock AJ, et al. Scaling up of HIV treatment for men who have sex with men in Bangkok: a modelling and costing study. Lancet HIV. 2015;2(5):e200–7. https://doi.org/10.1016/s2352-3018(15)00020-x.

    Article  PubMed  Google Scholar 

  12. Marseille E, Giganti MJ, Mwango A, Chisembele-Taylor A, Mulenga L, Over M, et al. Taking ART to scale: determinants of the cost and cost-effectiveness of antiretroviral therapy in 45 clinical sites in Zambia. PLoS ONE. 2012;7(12):e51993. https://doi.org/10.1371/journal.pone.0051993.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kim JJ, Maulsby C, Zulliger R, Jain K, Charles V, et al., Positive Charge Intervention Team. Cost and threshold analysis of positive charge, a multi-site linkage to HIV care program in the United States. AIDS Behav. 2015;19(10):1735–41. https://doi.org/10.1007/s10461-015-1124-9.

    Article  Google Scholar 

  14. Jain KM, Zulliger R, Maulsby C, Kim JJ, Charles V, et al., PCI Team. Cost–utility analysis of three U.S. HIV linkage and re-engagement in care programs from positive charge. AIDS Behav. 2016;20(5):973–6. https://doi.org/10.1007/s10461-015-1243-3.

    Article  Google Scholar 

  15. Spaulding AC, Pinkerton SD, Superak H, Cunningham MJ, Resch S, Jordan AO, et al. Cost analysis of enhancing linkages to HIV care following jail: a cost-effective intervention. AIDS Behav. 2013;17(Suppl 2):S220–6. https://doi.org/10.1007/s10461-012-0353-4.

    Article  PubMed  Google Scholar 

  16. Renaud A, Basenya O, de Borman N, Greindl I, Meyer-Rath G. The cost effectiveness of integrated care for people living with HIV including antiretroviral treatment in a primary health care centre in Bujumbura, Burundi. AIDS Care. 2009;21(11):1388–94. https://doi.org/10.1080/09540120902884042.

    Article  CAS  PubMed  Google Scholar 

  17. Jain KM, Maulsby C, Brantley M, Kim JJ, Zulliger R, et al., Team SIFi. Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs. AIDS Care 2016;28(9):1199–204. https://doi.org/10.1080/09540121.2016.1164294.

    Article  Google Scholar 

  18. Health Resources and Services Administration. HIV/AIDS Bureau performance measures. http://hab.hrsa.gov/deliverhivaidscare/coremeasures.pdf. Accessed 10 Oct 2017.

  19. Horberg MA, Aberg JA, Cheever LW, Renner P, O’Brien Kaleba E, Asch SM. Development of national and multiagency HIV care quality measures. Clin Infect Dis. 2010;51(6):732–8. https://doi.org/10.1086/655893 (Epub 19 Aug 2010).

    Article  Google Scholar 

  20. Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA. 2016;316(10):1093–103. https://doi.org/10.1001/jama.2016.12195.

    Article  Google Scholar 

  21. Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA. 1996;276(15):1253–8.

    Article  CAS  Google Scholar 

  22. Skarbinski J, Rosenberg E, Paz-Bailey G, Hall HI, Rose CE, Viall AH, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–96. https://doi.org/10.1001/jamainternmed.2014.8180.

    Article  PubMed  Google Scholar 

  23. Hall HI, Holtgrave DR, Tang T, Rhodes P. HIV transmission in the United States: considerations of viral load, risk behavior, and health disparities. AIDS Behav. 2013;17(5):1632–6. https://doi.org/10.1007/s10461-013-0426-z.

    Article  PubMed  Google Scholar 

  24. Farnham PG, Holtgrave DR, Gopalappa C, Hutchinson AB, Sansom SL. Lifetime costs and quality-adjusted life years saved from HIV prevention in the test and treat era. J Acquir Immune Defic Syndr. 2013;64(2):e15–8. https://doi.org/10.1097/qai.0b013e3182a5c8d4.

    Article  PubMed  Google Scholar 

  25. Holtgrave DR, Hall HI, Wehrmeyer L, Maulsby C. Costs, consequences and feasibility of strategies for achieving the goals of the national HIV/AIDS strategy in the United States: a closing window for success? AIDS Behav. 2012;16(6):1365–72. https://doi.org/10.1007/s10461-012-0207-0.

    Article  PubMed  Google Scholar 

  26. World Health Organization. Choosing interventions that are cost-effective: 2014. http://www.who.int/choice/en/. Accessed 10 Oct 2017.

  27. Robinson LA, Hammitt JK, Chang AY, Resch S. Understanding and improving the one and three times GDP per capita cost-effectiveness thresholds. Health Policy Plan. 2017;32(1):141–5. https://doi.org/10.1093/heapol/czw096.

    Article  PubMed  Google Scholar 

  28. World Bank. GDP per capita (current US$) 2013. http://data.worldbank.org/indicator/NY.GDP.PCAP.CD.

  29. Ubel PA, Hirth RA, Chernew ME, Fendrick AM. What is the price of life and why doesn’t it increase at the rate of inflation? Arch Intern Med. 2003;163(14):1637–41. https://doi.org/10.1001/archinte.163.14.1637.

    Article  PubMed  Google Scholar 

  30. Salzmann P, Kerlikowske K, Phillips K. Cost-effectiveness of extending screening mammography guidelines to include women 40 to 49 years of age. Ann Intern Med. 1997;127(11):955–65.

    Article  CAS  Google Scholar 

  31. Walensky RP. Cost-effectiveness of HIV interventions: from cohort studies and clinical trials to policy. Top HIV Med. 2009;17(4):130–4.

    PubMed  Google Scholar 

  32. Winkelmayer WC, Weinstein MC, Mittleman MA, Glynn RJ, Pliskin JS. Health economic evaluations: the special case of end-stage renal disease treatment. Med Decis Making. 2002;22(5):417–30.

    Article  Google Scholar 

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Acknowledgements

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 http://NationalService.gov.

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Authors and Affiliations

  1. Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 904C, Baltimore, MD, 21205, USA

    Catherine Maulsby, Kriti M. Jain, Brian W. Weir, Blessing Enobun & David R. Holtgrave

  2. AIDS United, 1424 K Street, N.W., Washington, DC, 20005, USA

    Melissa Werner & Morey Riordan

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  1. Catherine Maulsby
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A2C Intervention Team

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Correspondence to Catherine Maulsby.

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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.

Additional information

The A2C Intervention Team is comprised of the co-authors of this paper and representatives from each study site.

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Maulsby, C., Jain, K.M., Weir, B.W. et al. Cost–Utility of Access to Care, a National HIV Linkage, Re-engagement and Retention in Care Program. AIDS Behav 22, 3734–3741 (2018). https://doi.org/10.1007/s10461-017-2015-z

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  • DOI: https://doi.org/10.1007/s10461-017-2015-z

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