Cost-effectiveness of oral pre-exposure prophylaxis and expanded antiretroviral therapy for preventing HIV infections in the presence of drug resistance among men who have sex with men in China: A mathematical modelling study

Jin, Xiaodong; Shi, Lingen; Wang, Congyue; Qiu, Tao; Yin, Yi; Shen, Mingwang; Fu, Gengfeng; Peng, Zhihang

doi:10.1016/j.lanwpc.2022.100462

Cited by 9 publications

(9 citation statements)

References 49 publications

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“…This means that the treatment reduced the above progression rates by 1−ρs (1−ρr) and HIV-related death rates by 1−μs (1−μr) for drug-sensitive (drug-resistant) individuals, respectively. The per capita reversion rates of the above stages from lower CD4 + level to higher CD4 + level after effective treatment are w 1 , w 2 , w 3 , respectively, and we assumed that these reversion rates were the same among drug-sensitive and drug-resistant individuals [32,33]. The per capita attrition rates in the four stages are ηj( j = 1,2,3,4) and f r is the fraction of drug-resistant individuals among those with attrition.…”

Section: Methodsmentioning

confidence: 99%

“…We obtained the point estimate of the unknown parameters based on the NLS method and sampled these parameters within their ranges by the Latin hypercube sampling method and repeated 1000 times. In each simulation, we calculated the sum of square errors between the model output and data and selected the top 10% with the least square errors to generate 95% confidence intervals (95% CIs) [33]. Other model parameters were obtained from the published literature or the database from Guangxi CDC.…”

Section: Methodsmentioning

confidence: 99%

“…We obtained the recruitment rate and natural death rate from Guangxi Population and Employment Statistical Yearbook [31]. We chose disease-related progression rates and reversion rates from the published literature [32,33,35,38,39], which were assumed the same in different settings. However, for some setting-specific parameters (including per capita time-dependent diagnose rates and treatment rates, transmission rates, acquired drug-resistance rates, and HIV-related death rates) and the initial population size of each compartment, we estimated them using the nonlinear least-squares method (NLS) as listed in Appendix Tables S2-S3, http://links.lww.com/ QAD/C829.…”

Section: Model Calibrationmentioning

confidence: 99%

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The impact of attrition on the transmission of HIV and drug resistance

Shen

Xiao

Rong

et al. 2023

Aids

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Background: Attrition due to loss to follow-up or termination of antiretroviral therapy (ART) among HIV-infected patients in care may increase the risk of emergence and transmission of drug resistance (TDR), diminish benefit of treatment, and increase morbidity and mortality. Understanding the impact of attrition on the epidemic is essential to provide interventions for improving retention in care. Methods:We developed a comprehensive HIV transmission dynamics model by considering CD4 þ cell count dependent diagnosis, treatment, and attrition involving TDR and acquired drug resistance. The model was calibrated by 11 groups HIV/AIDS surveillance data during 2008-2018 from Guangxi, China, and validated by the prevalence of TDR among diagnosed treatment-naive individuals. We aimed to investigate how attrition would affect the transmission of HIV and drug-resistance when expanding ART.Results: In the base case with CD4 þ cell count dependent per capita attrition rates 0.025$0.15 and treatment rates 0.23$0.42, we projected cumulative total new infections, new drug-resistant infections, and HIV-related deaths over 2022-2030 would be 145 391, 7637, and 51 965, respectively.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Model Calibrationmentioning

confidence: 99%

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The impact of attrition on the transmission of HIV and drug resistance

Shen

Xiao

Rong

et al. 2023

Aids

Self Cite

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“…Another study found that safer-sex lectures and skills training for MSM significantly increased condom use rates, and the incremental cost of the intervention was less than the cost-effectiveness threshold (ie, US $13,000), indicating cost savings [ 6 ]. In China, some studies have also demonstrated the cost-effectiveness of different HIV-prevention strategies (ie, advocacy interventions, peer education, outreach services, and intervention staff training), including a risk-related behavioral intervention among female sex workers [ 7 ], active HIV voluntary counseling and testing among the general population [ 8 ], and oral pre-exposure prophylaxis and expanded antiretroviral therapy among MSM [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

A Cost-effectiveness Analysis of a Mobile Phone–Based Integrated HIV-Prevention Intervention Among Men Who Have Sex With Men in China: Economic Evaluation

Yun¹,

Yu²,

Liu³

et al. 2022

J Med Internet Res

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Background Mobile phone–based digital interventions have been shown to be a promising strategy for HIV prevention among men who have sex with men (MSM). Objective This study aimed to evaluate the cost-effectiveness of a mobile phone–based digital intervention for HIV prevention among MSM in China from the perspective of a public health provider. Methods The cost-effectiveness of the mobile phone–based digital intervention was estimated for a hypothetical cohort of 10,000 HIV-negative MSM who were followed for 1 year. A model was developed with China-specific data to project the clinical impact and cost-effectiveness of two mobile phone–based digital strategies for HIV prevention among MSM. The intervention group received an integrated behavioral intervention that included 1) individualized HIV infection risk assessment, 2) recommendation of centers testing for HIV and other STIs, 3) free online order of condoms and HIV and syphilis self-test kits and 4) educational materials about HIV/AIDS. The control group was only given educational materials about HIV/AIDS. Outcomes of interest were the number of HIV infections among MSM averted by the intervention, intervention costs, cost per HIV infection averted by the mobile phone–based digital intervention, and quality-adjusted life-years (QALYs). Univariate and multivariate sensitivity analyses were also conducted to examine the robustness of the results. Results It is estimated that the intervention can prevent 48 MSM from becoming infected with HIV and can save 480 QALYs. The cost of preventing 1 case of HIV infection was US $2599.87, and the cost-utility ratio was less than 0. Sensitivity analysis showed that the cost-effectiveness of the mobile phone–based digital intervention was mainly impacted by the average number of sexual behaviors with each sexual partner. Additionally, the higher the HIV prevalence among MSM, the greater the benefit of the intervention. Conclusions Mobile phone–based digital interventions are a cost-effective HIV-prevention strategy for MSM and could be considered for promotion and application among high-risk MSM subgroups.

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“…In The Lancet Regional Health - Western Pacific , Jin and colleagues 1 present a mathematical model of the costs and benefits of expanding pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) coverage while considering HIV drug-resistance among men who have sex with men (MSM) in Jiangsu Province, China. They concluded that expanding PrEP and ART is cost-effective among MSM even with drug-resistance, but expanded ART alone may be the most cost-effective policy.…”

mentioning

confidence: 99%