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Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models
BACKGROUND: In this so-called treat-all era, antiretroviral therapy (ART) interruptions contribute to an increasing proportion of HIV infections and deaths. Many strategies to improve retention on ART cost more than standard of care. In this study, we aimed to estimate the upper-bound costs at which...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Ltd
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9380252/ https://www.ncbi.nlm.nih.gov/pubmed/35961353 http://dx.doi.org/10.1016/S2214-109X(22)00310-2 |
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author | Bershteyn, Anna Jamieson, Lise Kim, Hae-Young Platais, Ingrida Milali, Masabho P Mudimu, Edinah ten Brink, Debra Martin-Hughes, Rowan Kelly, Sherrie L Phillips, Andrew N Bansi-Matharu, Loveleen Cambiano, Valentina Revill, Paul Meyer-Rath, Gesine Nichols, Brooke E |
author_facet | Bershteyn, Anna Jamieson, Lise Kim, Hae-Young Platais, Ingrida Milali, Masabho P Mudimu, Edinah ten Brink, Debra Martin-Hughes, Rowan Kelly, Sherrie L Phillips, Andrew N Bansi-Matharu, Loveleen Cambiano, Valentina Revill, Paul Meyer-Rath, Gesine Nichols, Brooke E |
author_sort | Bershteyn, Anna |
collection | PubMed |
description | BACKGROUND: In this so-called treat-all era, antiretroviral therapy (ART) interruptions contribute to an increasing proportion of HIV infections and deaths. Many strategies to improve retention on ART cost more than standard of care. In this study, we aimed to estimate the upper-bound costs at which such interventions should be adopted. METHODS: In this combined analysis, we compared the infections averted, disability-adjusted life-years (DALYs) averted, and upper-bound costs of interventions that improve ART retention in three HIV models with diverse structures, assumptions, and baseline settings: EMOD in South Africa, Optima in Malawi, and Synthesis in sub-Saharan African low-income and middle-income countries (LMICs). We modelled estimates over a 40-year time horizon, from a baseline of Jan 1, 2022, when interventions would be implemented, to Jan 1, 2062. We varied increment of ART retention (25%, 50%, 75%, and 100% retention), the extent to which interventions could be targeted towards individuals at risk of interrupting ART, and cost-effectiveness thresholds in each setting. FINDINGS: Despite simulating different settings and epidemic trends, all three models produced consistent estimates of health benefit (ie, DALYs averted) and transmission reduction per increment in retention. The range of estimates was 1·35–3·55 DALYs and 0·12–0·20 infections averted over the 40-year time horizon per additional person-year retained on ART. Upper-bound costs varied by setting and intervention effectiveness. Improving retention by 25% among all people receiving ART, regardless of risk of ART interruption, gave an upper-bound cost per person-year of US$2–6 in Optima (Malawi), $43–68 in Synthesis (LMICs in sub-Saharan Africa), and $28–180 in EMOD (South Africa). A maximally targeted and effective retention intervention had an upper-bound cost per person-year of US$93–223 in Optima (Malawi), $871–1389 in Synthesis (LMICs in sub-Saharan Africa), and $1013–6518 in EMOD (South Africa). INTERPRETATION: Upper-bound costs that could improve ART retention vary across sub-Saharan African settings and are likely to be similar to or higher than was estimated before the start of the treat-all era. Upper-bound costs could be increased by targeting interventions to those most at risk of interrupting ART. FUNDING: Bill & Melinda Gates Foundation. |
format | Online Article Text |
id | pubmed-9380252 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-93802522022-08-17 Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models Bershteyn, Anna Jamieson, Lise Kim, Hae-Young Platais, Ingrida Milali, Masabho P Mudimu, Edinah ten Brink, Debra Martin-Hughes, Rowan Kelly, Sherrie L Phillips, Andrew N Bansi-Matharu, Loveleen Cambiano, Valentina Revill, Paul Meyer-Rath, Gesine Nichols, Brooke E Lancet Glob Health Articles BACKGROUND: In this so-called treat-all era, antiretroviral therapy (ART) interruptions contribute to an increasing proportion of HIV infections and deaths. Many strategies to improve retention on ART cost more than standard of care. In this study, we aimed to estimate the upper-bound costs at which such interventions should be adopted. METHODS: In this combined analysis, we compared the infections averted, disability-adjusted life-years (DALYs) averted, and upper-bound costs of interventions that improve ART retention in three HIV models with diverse structures, assumptions, and baseline settings: EMOD in South Africa, Optima in Malawi, and Synthesis in sub-Saharan African low-income and middle-income countries (LMICs). We modelled estimates over a 40-year time horizon, from a baseline of Jan 1, 2022, when interventions would be implemented, to Jan 1, 2062. We varied increment of ART retention (25%, 50%, 75%, and 100% retention), the extent to which interventions could be targeted towards individuals at risk of interrupting ART, and cost-effectiveness thresholds in each setting. FINDINGS: Despite simulating different settings and epidemic trends, all three models produced consistent estimates of health benefit (ie, DALYs averted) and transmission reduction per increment in retention. The range of estimates was 1·35–3·55 DALYs and 0·12–0·20 infections averted over the 40-year time horizon per additional person-year retained on ART. Upper-bound costs varied by setting and intervention effectiveness. Improving retention by 25% among all people receiving ART, regardless of risk of ART interruption, gave an upper-bound cost per person-year of US$2–6 in Optima (Malawi), $43–68 in Synthesis (LMICs in sub-Saharan Africa), and $28–180 in EMOD (South Africa). A maximally targeted and effective retention intervention had an upper-bound cost per person-year of US$93–223 in Optima (Malawi), $871–1389 in Synthesis (LMICs in sub-Saharan Africa), and $1013–6518 in EMOD (South Africa). INTERPRETATION: Upper-bound costs that could improve ART retention vary across sub-Saharan African settings and are likely to be similar to or higher than was estimated before the start of the treat-all era. Upper-bound costs could be increased by targeting interventions to those most at risk of interrupting ART. FUNDING: Bill & Melinda Gates Foundation. Elsevier Ltd 2022-08-09 /pmc/articles/PMC9380252/ /pubmed/35961353 http://dx.doi.org/10.1016/S2214-109X(22)00310-2 Text en © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Articles Bershteyn, Anna Jamieson, Lise Kim, Hae-Young Platais, Ingrida Milali, Masabho P Mudimu, Edinah ten Brink, Debra Martin-Hughes, Rowan Kelly, Sherrie L Phillips, Andrew N Bansi-Matharu, Loveleen Cambiano, Valentina Revill, Paul Meyer-Rath, Gesine Nichols, Brooke E Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models |
title | Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models |
title_full | Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models |
title_fullStr | Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models |
title_full_unstemmed | Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models |
title_short | Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models |
title_sort | transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9380252/ https://www.ncbi.nlm.nih.gov/pubmed/35961353 http://dx.doi.org/10.1016/S2214-109X(22)00310-2 |
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