Dataset Information

The impact of localized implementation: determining the cost-effectiveness of HIV prevention and care interventions across six United States cities.

ABSTRACT:

Objective

Effective interventions to reduce the public health burden of HIV/AIDS can vary in their ability to deliver value at different levels of scale and in different epidemiological contexts. Our objective was to determine the cost-effectiveness of HIV treatment and prevention interventions implemented at previously documented scales of delivery in six US cities with diverse HIV microepidemics.

Design

Dynamic HIV transmission model-based cost-effectiveness analysis.

Methods

We identified and estimated previously documented scale of delivery and costs for 16 evidence-based interventions from the US CDC's Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention. Using a model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City and Seattle, we estimated averted HIV infections, quality-adjusted life years (QALY) gained and incremental cost-effectiveness ratios (healthcare perspective; 3% discount rate, 2018$US), for each intervention and city (10-year implementation) compared with the status quo over a 20-year time horizon.

Results

Increased HIV testing was cost-saving or cost-effective across cities. Targeted preexposure prophylaxis for high-risk MSM was cost-saving in Miami and cost-effective in Atlanta ($6123/QALY), Baltimore ($18?333/QALY) and Los Angeles ($86?117/QALY). Interventions designed to improve antiretroviral therapy initiation provided greater value than other treatment engagement interventions. No single intervention was projected to reduce HIV incidence by more than 10.1% in any city.

Conclusion

Combination implementation strategies should be tailored to local epidemiological contexts to provide the most value. Complementary strategies addressing factors hindering access to HIV care will be necessary to meet targets for HIV elimination in the United States.

SUBMITTER: Krebs E

PROVIDER: S-EPMC7046093 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Publications

The impact of localized implementation: determining the cost-effectiveness of HIV prevention and care interventions across six United States cities.

Krebs Emanuel E Zang Xiao X Enns Benjamin B Min Jeong E JE Behrends Czarina N CN Del Rio Carlos C Dombrowski Julia C JC Feaster Daniel J DJ Gebo Kelly A KA Golden Matthew M Marshall Brandon D L BDL Metsch Lisa R LR Schackman Bruce R BR Shoptaw Steven S Strathdee Steffanie A SA Nosyk Bohdan B

AIDS (London, England) 20200301 3

<h4>Objective</h4>Effective interventions to reduce the public health burden of HIV/AIDS can vary in their ability to deliver value at different levels of scale and in different epidemiological contexts. Our objective was to determine the cost-effectiveness of HIV treatment and prevention interventions implemented at previously documented scales of delivery in six US cities with diverse HIV microepidemics.<h4>Design</h4>Dynamic HIV transmission model-based cost-effectiveness analysis.<h4>Methods ...[more]

PMID: 31794521

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Project description:Background:As more effective or efficient interventions emerge out of scientific advancement to address a particular public health issue, it may be appropriate to de-implement low-value interventions, or interventions that are less effective or efficient. Furthermore, factors that contribute to appropriate de-implementation are not well identified. We examined the extent to which low-value interventions were de-implemented among public health organizations providing HIV prevention services, as well as explored socio-economic, organizational, and intervention characteristics associated with de-implementation. Methods:We conducted an online cross-sectional survey from the fall of 2017 to the spring of 2019 with organizations (N = 188) providing HIV prevention services in the USA. Organizations were recruited from the Center for Disease Control and Prevention's (CDC) website gettested.org from 20 metropolitan statistical areas with the highest HIV incidence. An organization was eligible to participate if the organization had provided at least one of the HIV prevention interventions identified as inefficient by the CDC in the last ten years, and one administrator familiar with HIV prevention programming at the organization was recruited to respond. Complete responses were analyzed to describe intervention de-implementation and identify organizational and intervention characteristics associated with de-implementation using logistic regression. Results:Organizations reported 359 instances of implementing low-value interventions. Out of the low-value interventions implemented, approximately 57% were group, 34% were individual, and 5% were community interventions. Of interventions implemented, 46% had been de-implemented. Although we examined a number of intervention and organizational factors thought to be associated with de-implementation, the only factor statistically associated with de-implementation was organization size, with larger organizations-those with 50+ FTEs-being 3.1 times more likely to de-implement than smaller organizations (95% CI 1.3-7.5). Conclusions:While low-value interventions are frequently de-implemented among HIV prevention organizations, many persisted representing substantial inefficiency in HIV prevention service delivery. Further exploration is needed to understand why organizations may opt to continue low-value interventions and the factors that lead to de-implementation.

Project description:BackgroundTo guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised.ObjectiveTo identify and describe the prevalence of specific hospital fall prevention implementation strategies.MethodsIn 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables.ResultsA total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff).ConclusionsOur study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions.

Project description:Racial and ethnic minorities are disproportionately affected by HIV/AIDS in the United States despite advances in prevention methodologies. The goal of this study was to systematically review the past 30 years of HIV prevention interventions addressing racial disparities. We conducted electronic searches of Medline, PsycINFO, CINAHL, and Cochrane Review of Clinical Trials databases, supplemented by manual searches and expert review. Studies published before June 5, 2011 were eligible. Prevention interventions that included over 50% racial/ethnic minority participants or sub-analysis by race/ethnicity, measured condom use only or condom use plus incident sexually transmitted infections or HIV as outcomes, and were affiliated with a health clinic were included in the review. We stratified the included articles by target population and intervention modality. Reviewers independently and systematically extracted all studies using the Downs and Black checklist for quality assessment; authors cross-checked 20% of extractions. Seventy-six studies were included in the final analysis. The mean DB score was 22.44--high compared to previously published means. Most of the studies were randomized controlled trials (87%) and included a majority of African-American participants (83%). No interventions were designed specifically to reduce disparities in HIV acquisition between populations. Additionally, few interventions targeted men who have sex with men or utilized HIV as a primary outcome. Interventions that combined skills training and cultural or interactive engagement of participants were superior to those depending on didactic messaging. The scope of this review was limited by the exclusion of non-clinic based interventions and intermediate risk endpoints. Interactive, skills-based sessions may be effective in preventing HIV acquisition in racial and ethnic minorities, but further research into interventions tailored to specific sub-populations, such as men who have sex with men, is warranted.

Project description:BACKGROUND AND AIMS:Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States. We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting. DESIGN:An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from an HIV outbreak investigation in Indiana. SETTING:Scott County, Indiana (population 24?181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence among PWID in 2015. PARTICIPANTS:PWID. MEASUREMENTS:Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programmes (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without re-treatment of re-infections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting. FINDINGS:To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 24.9% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 14.5%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (19.9%) need treatment annually. These treatment requirements are threefold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment. CONCLUSIONS:Combined scale-up of hepatitis C virus treatment and prevention interventions is needed to decrease the increasing burden of hepatitis C virus incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.

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Dataset Information

The impact of localized implementation: determining the cost-effectiveness of HIV prevention and care interventions across six United States cities.

Objective

Design

Methods

Results

Conclusion

Publications

The impact of localized implementation: determining the cost-effectiveness of HIV prevention and care interventions across six United States cities.

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