HIV Testing Among Men Who Have Sex With Men

Roark, Randall A.; Webster, Rob; Darrow, William W.; Stempel, Robert R.

doi:10.1097/00124784-200501000-00004

Cited by 5 publications

(1 citation statement)

References 9 publications

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“…CDC guidelines call for annual screening (68), although in practice not all at-risk individuals are screened. We estimated that 75% of individuals whose HIV status is unknown are screened each year (69)(70)(71)(72). We assumed that individuals whose CD4 count is greater than 350 cells/mm 3 are asymptomatic.…”

Section: Treatment Before Haartmentioning

confidence: 99%

The Cost-Effectiveness of Counseling Strategies to Improve Adherence to Highly Active Antiretroviral Therapy among Men Who Have Sex with Men

et al. 2008

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Objective-Inadequate adherence to highly active antiretroviral therapy (HAART) may lead to poor health outcomes and the development of HIV strains that are resistant to HAART. We developed a model to evaluate the cost effectiveness of counseling interventions to improve adherence to HAART among men who have sex with men (MSM).Methods-We developed a dynamic compartmental model that incorporates HIV treatment, adherence to treatment, and infection transmission and progression. All data estimates were obtained from secondary sources. We evaluated a counseling intervention given prior to initiation of HAART and before all changes in drug regimens, combined with phone-in support while on HAART. We considered a moderate-prevalence and a high-prevalence population of MSM.Results-If the impact of HIV transmission is ignored, the counseling intervention has a costeffectiveness ratio of $25,500 per QALY gained. When HIV transmission is included, the costeffectiveness ratio is much lower: $7,400 and $8,700 per QALY gained in the moderate-and highprevalence populations, respectively. When the intervention is twice as costly per counseling session and half as effective as we estimated (in terms of the number of individuals who become highly adherent, and who remain highly adherent), then the intervention costs $17,100 and $19,600 per QALY gained in the two populations, respectively.Conclusions-Counseling to improve adherence to HAART increased length of life, modestly reduced HIV transmission, and cost substantially less than $50,000 per QALY gained over a wide range of assumptions, but did not reduce the proportion of drug-resistant strains. Such counseling provides only modest benefit as a tool for HIV prevention, but can provide significant benefit for individual patients at an affordable cost. Keywords NIH-PA Author ManuscriptA number of strategies have been proposed to improve adherence to highly active antiretroviral therapy (HAART), including electronic reminders (1), easier-to-follow regimens (1-3), medication under supervised settings (4, 5), self-monitoring (6), counseling sessions (6), and other strategies (7,8). Recent reviews have identified aspects of successful strategies to improve adherence (9-15). However, some strategies to improve HIV adherence "require considerable resources, and adherence is typically not sustained after the intervention is withdrawn" (15).Since resistant HIV strains can be transmitted to others, improved adherence to HAART benefits not only those whose adherence is increased, but also those whom they may infect. Two recent papers examined the effectiveness (16) and cost effectiveness (17) of interventions to improve adherence to HAART, but did not account for changes in HIV transmission. To estimate the impact of improved adherence on the development and transmission of resistant strains of HIV, a model that incorporates mixing and infection transmission is needed. Recent papers have highlighted the importance of considering HIV transmission, resistance, and viral load when ev...

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Section: Treatment Before Haartmentioning

confidence: 99%