In 2015, the US government released a 5-year plan known as the National HIV/AIDS Strategy that outlined methods to lower the incidence of HIV infection and slow down the epidemic. The actions were predicated on “90-90-90” goals-90% of people with HIV would be diagnosed, 90% of those diagnosed would receive antiretroviral therapy (ART), and 90% of patients on ART would achieve viral suppression and be noninfectious by 2020.
Last year, the government revised this plan somewhat by announcing the goal of reducing new infections by 75% within 5 years and by 90% within a decade. However, along with possible increased funding in certain areas, the administration has implemented crucial budget cuts to programs that enable vulnerable citizens to access needed medical care and drugs. Meanwhile, thousands of new HIV cases continue to be diagnosed each year in the US, disproportionately affecting black and Hispanic men who engage in sex with other men.
A team of investigators from the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, along with colleagues at other public health and medical institutions, completed an economic modeling study of 6 US cities in order to determine the evidence-based interventions that would result in better health outcomes in the most cost-effective manner. The study, which was published in The Lancet, simulated outbreaks in each city, then examined multiple combinations of strategies to prevent HIV, expand testing, increase treatment rates, and retain and re-engage patients in care.
The study’s focus was the number of HIV infections, quality-adjusted life years (QALYs), total costs, and incremental cost-effectiveness ratio (ICER), which measures the cost effectiveness of a particular health intervention compared with others. Modeling forecasts looked at outcomes through 2040.