The Cost-Effectiveness of HIV/STI Prevention in High-Income Countries with Concentrated Epidemic Settings: A Scoping Review

Brunner, Palmo; Brunner, Karma; Kübler, Daniel

doi:10.1007/s10461-022-03583-y

Cited by 4 publications

(2 citation statements)

References 174 publications

(203 reference statements)

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“…[5][6][7] RCTs of HIV screening strategies have also been reported in studies outside of the United States, including Africa, [8][9][10][11] Australia, United Kingdom, 13 and China. [14][15][16] Cost-effectiveness analyses of HIV screening strategies have used conventional modeling methods, such as decision trees, Markov models, dynamic models, and individual-and population-based models, [17][18][19][20][21][22] while mostly using cohort data as model inputs with a few studies using RCT data to calibrate the model. 22,23 However, net-benefit regression 24 can also be used to conduct cost-effectiveness analyses of HIV screening strategies using person-level data obtained from an RCT.…”

Section: Introductionmentioning

confidence: 99%

Estimating the Cost-Effectiveness of HIV Self-Testing in the United States Using Net Benefit Regression

Islam,

Shrestha,

Hoch

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Cost-effectiveness analysis of HIV self-testing using patient-level data from a randomized clinical trial can inform HIV prevention funding decisions. Cost-effectiveness analysis using net benefit regression addresses the sampling uncertainty in the trial data and the variability of policymakers’ willingness to pay (WTP). Methods: We used published data from a 12-month longitudinal randomized clinical trial that enrolled 2665 men who sex with men (MSM) randomly assigned to the self-testing arm (participants receiving self-test kits) and control arm (participants receiving standard-of-care), and the self-testing arm identified 48 additional new HIV cases. We used net benefit regression to investigate the cost-effectiveness of an HIV self-testing intervention, which compared the incremental cost per new HIV diagnosis with policymakers’ WTP thresholds. We addressed the uncertainties in estimating the incremental cost and the policymakers’ WTP per new diagnosis through the incremental net benefit (INB) regression and cost-effectiveness acceptability curve (CEAC) analyses. Results: From the healthcare provider’s perspective, the INB analysis showed a positive net-benefit of HIV self-testing compared to standard-of-care when policymakers’ WTP per new HIV diagnosis was $9,365 (95% CI: $5,700 - $25,500) or higher. The CEAC showed that the probability of HIV self-testing being cost-effective compared to standard-of-care was 58% and >99% at a WTP of $10 000 and $50 000 per new HIV diagnosis, respectively. Conclusion: The INB and CEAC analyses suggest that HIV self-testing has the potential to be cost-effective for relatively low values of policymakers’ WTP.

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Section: Introductionmentioning

confidence: 99%

Estimating the Cost-Effectiveness of HIV Self-Testing in the United States Using Net Benefit Regression

Islam,

Shrestha,

Hoch

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…To prevent the HIV epidemic, a series of HIV biomedical interventions have been developed, including a so-called ‘test and treat’ combination, treatment as prevention, vaccination and oral pre-exposure prophylaxis (PrEP) [ 7 ]. PrEP is a highly effective biological prevention method for individuals at high risk of HIV [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to uptake and use of oral pre-exposure prophylaxis in pregnant and postpartum women: a qualitative meta-synthesis

Liu,

Zhang,

Chen

2024

BMC Public Health

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Background Acute HIV infection during pregnancy and in the postpartum period increases the risk of vertical transmission. The World Health Organization (WHO) has recommended preexposure prophylaxis for pregnant and postpartum women at risk of acquiring HIV. However, there are significant gaps between the actual practice and the ideal goal of preexposure prophylaxis implementation among pregnant and postpartum women. Therefore, it is important to determine what influences women’s implementation of preexposure prophylaxis during pregnancy and in the postpartum period. This review aims to aggregate barriers and facilitators to preexposure prophylaxis implementation among pregnant and postpartum women. Methods A range of electronic databases, including PubMed, CINAHL Plus with Full Text, Embase, and Web of Science, were searched for potentially relevant qualitative studies. The search period extended from the establishment of the databases to March 16, 2023. This review used the ENTREQ (Enhancing transparency in reporting of qualitative research synthesis) statement to guide the design and reporting of qualitative synthesis. The methodological quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The JBI meta-aggregation method was applied for guiding the data extraction, and the JBI ConQual method was applied for guiding the evaluation of the level of evidence for the synthesis. Results Of retrieved 2042 studies, 12 met the inclusion criteria. The total population sample included 447 participants, including 231 pregnant and postpartum women, 21 male partners, 75 healthcare providers (HCPs)/healthcare workers (HCWs), 18 policymakers, 37 mothers, and 65 women of childbearing age. A total of 149 findings with credibility ratings of “unequivocal” or “equivocal” were included in this meta-synthesis. Barriers and facilitators to preexposure prophylaxis implementation were coded into seven categories, including three facilitator categories: perceived benefits, maintaining relationships with partners, and external support, and four barriers: medication-related barriers, stigma, barriers at the level of providers and facilities, and biases in risk perception. Conclusion This systematic review and meta-synthesis aggregated the barriers and facilitators of preexposure prophylaxis implementation among pregnant and postpartum women. We aggregated several barriers to maternal preexposure prophylaxis implementation, including medication-related factors, stigma, barriers at the level of providers and facilities, and risk perception biases. Therefore, intervention measures for improving preexposure prophylaxis services can be developed based on these points. PROSPERO Number CRD42023412631.

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Principles for Ending Human Immunodeficiency Virus as an Epidemic in the United States: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association

Person

Armstrong

Evans

et al. 2022

Clinical Infectious Diseases

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The National HIV/AIDS Strategy for 2022-2025 and the federal Ending the HIV Epidemic (EHE) initiative1,2 have an ambitious goal of dramatically reducing new HIV infections in the United States. by 90% by 2030. While we have the tools to achieve that, the persistent barriers to healthcare services experienced by too many individuals will need to be addressed to make significant progress and improve the health and quality of life of all people living with HIV. The necessary structural changes require actions by federal, state and local policymakers and range from ensuring universal access to healthcare services to optimizing care delivery to ensuring a robust and diverse ID and HIV workforce. This paper outlines ten key principles for policy reforms that if advanced would make ending the HIV epidemic in the U.S. possible and could have much more far-reaching effects in improving the health of our nation.

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The Cost-Effectiveness of HIV/STI Prevention in High-Income Countries with Concentrated Epidemic Settings: A Scoping Review

Cited by 4 publications

References 174 publications

Estimating the Cost-Effectiveness of HIV Self-Testing in the United States Using Net Benefit Regression

Estimating the Cost-Effectiveness of HIV Self-Testing in the United States Using Net Benefit Regression

Barriers and facilitators to uptake and use of oral pre-exposure prophylaxis in pregnant and postpartum women: a qualitative meta-synthesis

Principles for Ending Human Immunodeficiency Virus as an Epidemic in the United States: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association

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