Dataset Information

A New Method for Estimating the Number of Undiagnosed HIV Infected Based on HIV Testing History, with an Application to Men Who Have Sex with Men in Seattle/King County, WA.

ABSTRACT: We develop a new approach for estimating the undiagnosed fraction of HIV cases, the first step in the HIV Care Cascade. The goal is to address a critical blindspot in HIV prevention and treatment planning, with an approach that simplifies data requirements and can be implemented with open-source software. The primary data required is HIV testing history information on newly diagnosed cases. Two methods are presented and compared. The first is a general methodology based on simplified back-calculation that can be used to assess changes in the undiagnosed fraction over time. The second makes an assumption of constant incidence, allowing the estimate to be expressed as a simple closed formula calculation. We demonstrate the methods with an application to HIV diagnoses among men who have sex with men (MSM) from Seattle/King County. The estimates suggest that 6% of HIV-infected MSM in King County are undiagnosed, about one-third of the comparable national estimate. A sensitivity analysis on the key distributional assumption gives an upper bound of 11%. The undiagnosed fraction varies by race/ethnicity, with estimates of 4.9% among white, 8.6% of African American, and 9.3% of Hispanic HIV-infected MSM being undiagnosed.

SUBMITTER: Fellows IE

PROVIDER: S-EPMC4510124 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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A New Method for Estimating the Number of Undiagnosed HIV Infected Based on HIV Testing History, with an Application to Men Who Have Sex with Men in Seattle/King County, WA.

Fellows Ian E IE Morris Martina M Birnbaum Jeanette K JK Dombrowski Julia C JC Buskin Susan S Bennett Amy A Golden Matthew R MR

PloS one 20150721 7

We develop a new approach for estimating the undiagnosed fraction of HIV cases, the first step in the HIV Care Cascade. The goal is to address a critical blindspot in HIV prevention and treatment planning, with an approach that simplifies data requirements and can be implemented with open-source software. The primary data required is HIV testing history information on newly diagnosed cases. Two methods are presented and compared. The first is a general methodology based on simplified back-calcul ...[more]

PMID: 26196132

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Project description:IntroductionPromising HIV vaccine candidates are steadily progressing through the clinical trial pipeline. Once available, HIV vaccines will be an important complement but also potential competitor to other biomedical prevention tools such as pre-exposure prophylaxis (PrEP). Accordingly, the value of HIV vaccines and the policies for rollout may depend on that interplay and tradeoffs with utilization of existing products. In this economic modelling analysis, we estimate the cost-effectiveness of HIV vaccines considering their potential interaction with PrEP and condom use.MethodsWe developed a dynamic model of HIV transmission among the men who have sex with men population (MSM), aged 15-64 years, in Seattle, WA offered PrEP and HIV vaccine over a time horizon of 2025-2045. A healthcare sector perspective with annual discount rate of 3% for costs (2017 USD) and quality-adjusted life years (QALYs) was used. The primary economic endpoint is the incremental cost-effectiveness ratio (ICER) when compared to no HIV vaccine availability.ResultsHIV vaccines improved population health and increased healthcare costs. Vaccination campaigns achieving 90% coverage of high-risk men and 60% coverage of other men within five years of introduction are projected to avoid 40% of new HIV infections between 2025 and 2045. This increased total healthcare costs by $30 million, with some PrEP costs shifted to HIV vaccine spending. HIV vaccines are estimated to have an ICER of $42,473/QALY, considered cost-effective using a threshold of $150,000/QALY. Results were most sensitive to HIV vaccine efficacy and future changes in the cost of PrEP drugs. Sensitivity analysis found ranges of 30-70% HIV vaccine efficacy remained cost-effective. Results were also sensitive to reductions in condom use among PrEP and vaccine users.ConclusionsAccess to an HIV vaccine is desirable as it could increase the overall effectiveness of combination HIV prevention efforts and improve population health. Planning for the rollout and scale-up of HIV vaccines should carefully consider the design of policies that guide interactions between vaccine and PrEP utilization and potential competition.

Dataset Information

A New Method for Estimating the Number of Undiagnosed HIV Infected Based on HIV Testing History, with an Application to Men Who Have Sex with Men in Seattle/King County, WA.

Publications

A New Method for Estimating the Number of Undiagnosed HIV Infected Based on HIV Testing History, with an Application to Men Who Have Sex with Men in Seattle/King County, WA.

Similar Datasets

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