Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Feb 6;10(2):e0116694.
doi: 10.1371/journal.pone.0116694. eCollection 2015.

Cost-effectiveness analysis of brief and expanded evidence-based risk reduction interventions for HIV-infected people who inject drugs in the United States

Dahye L Song  1 , Frederick L Altice  2 , Michael M Copenhaver  3 , Elisa F Long  4
Affiliations

Cost-effectiveness analysis of brief and expanded evidence-based risk reduction interventions for HIV-infected people who inject drugs in the United States

Dahye L Song et al. PLoS One. .

Abstract

Aims: Two behavioral HIV prevention interventions for people who inject drugs (PWID) infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+), a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+) Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST), to the status quo in the U.S.

Methods: A dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs) gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy.

Results: Over 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY), and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone.

Conclusions: Both behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Estimated Number of New HIV Infections over 10 Years among PWID and Non-PWID for Each Strategy.
HHRP+: Holistic Health Recovery Program for HIV+; HIV: human immunodeficiency virus; OST: opioid substitution therapy; PWID: people who inject drugs; 3H+: Holistic Health for HIV.
Fig 2
Fig 2. Estimated HIV Prevalence among PWID and Non-PWID.
HHRP+: Holistic Health Recovery Program for HIV+; HIV: human immunodeficiency virus; OST: opioid substitution therapy; PWID: people who inject drugs; 3H+: Holistic Health for HIV.
Fig 3
Fig 3. Cost-Effectiveness of Intervention Strategies.
HHRP+: Holistic Health Recovery Program for HIV+; OST: opioid substitution therapy; QALY: quality-adjusted life year; 3H+: Holistic Health for HIV.
Fig 4
Fig 4. Relative Effectiveness vs. Cost of 3H+ vs. HHRP+.
HHRP+: Holistic Health Recovery Program for HIV+; 3H+: Holistic Health for HIV.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Centers for Disease Control and Prevention (CDC) (2012) Estimated HIV incidence in the United States, 2007–2010. Available: http://www.cdc.gov/hiv/pdf/statistics_hssr_vol_17_no_4.pdf. Accessed 7 October 2013.
    1. Centers for Disease Control and Prevention (CDC) (2009) HIV infection among injection-drug users—34 states, 2004–2007. MMWR Morb Mortal Wkly Rep 58: 1291–1295. - PubMed
    1. Rachlis B, Brouwer KC, Mills EJ, Hayes M, Kerr T, et al. (2007) Migration and transmission of blood-borne infections among injection drug users: understanding the epidemiologic bridge. Drug Alcohol Depend 90: 107–119. 10.1016/j.drugalcdep.2007.03.014 - DOI - PubMed
    1. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, et al. (2011) Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365: 493–505. 10.1056/NEJMoa1105243 - DOI - PMC - PubMed
    1. Anglemyer A, Rutherford GW, Egger M, Siegfried N (2011) Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev. doi:10.1002/14651858.CD009153. - PubMed

Publication types