A Decision Analytics Model to Optimize Investment in Interventions Targeting the HIV PrEP Cascade of Care

Details

• Alternative Title:
  AIDS
• Personal Author:
  Jenness, Samuel M. ; Knowlton, Gregory ; Smith, Dawn K. ; Marcus, Julia L. ; Anderson, Emeli J. ; Siegler, Aaron J. ; Jones, Jeb ; Sullivan, Patrick S. ; Enns, Eva
• Description:
  Objectives
  
  Gaps between recommended and actual levels of HIV preexposure prophylaxis (PrEP) use remain among men who have sex with men (MSM). Interventions can address these gaps, but it is unknown how public health initiatives should invest prevention funds into these interventions to maximize their population impact.
  
  Design
  
  We used a stochastic network-based HIV transmission model for MSM in the Atlanta area paired with an economic budget optimization model.
  
  Methods
  
  The model simulated MSM participating in up to three real-world PrEP cascade interventions designed to improve initiation, adherence, or persistence. The primary outcome was infections averted over 10 years. The budget optimization model identified the investment combination under different budgets that maximized this outcome given intervention costs from a payer perspective.
  
  Results
  
  From the base 15% PrEP coverage level, the three interventions could increase coverage to 27%, resulting in 12.3% of infections averted over 10 years. Uptake of each intervention was interdependent: maximal use of the adherence and persistence interventions depended on new PrEP users generated by the initiation intervention. As the budget increased, optimal investment involved a mixture of the initiation and persistence interventions, but not the adherence intervention. If adherence intervention costs were halved, the optimal investment was roughly equal across interventions.
  
  Conclusions
  
  Investments into the PrEP cascade through initiatives should account for the interactions of the interventions as they are collectively deployed. Given current intervention efficacy estimates, the total population impact of each intervention may be improved with greater total budgets or reduced intervention costs.
  
  
• Subjects:
  Anti-HIV Agents HIV Infections Homosexuality, Male Humans Male Pre-Exposure Prophylaxis Sexual And Gender Minorities
• Source:
  AIDS. 35(9):1479-1489
• Pubmed ID:
  33831910
• Pubmed Central ID:
  PMC8243826
• Document Type:
  Journal Article
• Funding:
  K01 AI122853/AI/NIAID NIH HHSUnited States/ ; R01 AI138783/AI/NIAID NIH HHSUnited States/ ; U38 PS004646/PS/NCHHSTP CDC HHSUnited States/
• Volume:
  35
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:2de45eec7f103a8c056f4f983b68b0abaeef50abd7d198a45b2c2acccca63735
• Download URL:
  https://stacks.cdc.gov/view/cdc/107694/cdc_107694_DS1.pdf
• File Type:
  [PDF - 917.91 KB ]