Modeling Adherence Interventions Among Youth with HIV in the United States: Clinical and Economic Projections

Neilan, Anne M.; Bangs, Audrey C.; Hudgens, Michael G.; Patel, Kunjal; Agwu, Allison L.; Bassett, Ingrid V.; Gaur, Aditya H.; Hyle, Emily P; Crespi, Catherine M.; Horvath, Keith J.; Dugdale, Caitlin M; Powers, Kimberly A.; Rendina, H. Jonathon; Weinstein, Milton C.; Walensky, Rochelle P.; Freedberg, Kenneth A.; Ciaranello, Andrea

doi:10.1007/s10461-021-03169-0

Cited by 7 publications

(32 citation statements)

References 61 publications

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“…Additionally, the higher the vulnerability, the more frequently respondents were non-persistent to their ART (i.e., missed taking ART at least 4 days in a row). Given the presence of over 50,000 YLWH in the US (27) and sub-optimal HIV outcomes among YLWH (3)(4)(5) death by 12% over 12 months (8). Additionally, adherencepromoting interventions would be considered cost-effective even at a cost of $2,000 per month per person or efficacy as low as 1% increase in virologic suppression (8).…”

Section: Discussionmentioning

confidence: 99%

“…Given the presence of over 50,000 YLWH in the US (27) and sub-optimal HIV outcomes among YLWH (3)(4)(5) death by 12% over 12 months (8). Additionally, adherencepromoting interventions would be considered cost-effective even at a cost of $2,000 per month per person or efficacy as low as 1% increase in virologic suppression (8). Given that interventions using mobile technologies are increasingly examined as cost-effective mechanisms to improve HIV care outcomes (11,12), our findings suggest the need to measure mobile technology vulnerability as means to identify potential pitfalls, such as disconnection to phone services and being lost to follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Given the presence of over 50,000 YLWH in the US ( 27 ) and sub-optimal HIV outcomes among YLWH ( 3 - 5 ), development and evaluation of interventions to achieve and maintain virologic suppression is a clinical and public health priority. Prior research has shown that ART adherence-promoting interventions that have led to a 10% increase in virologic suppression among YLWH have reduced onward transmission of HIV by 15% and death by 12% over 12 months ( 8 ). Additionally, adherence-promoting interventions would be considered cost-effective even at a cost of $2,000 per month per person or efficacy as low as 1% increase in virologic suppression ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

“…ART non-adherence can result in drug resistance, secondary transmission of drug resistance, reduced quality of life, and increased mortality (5)(6)(7). Interventions that improve ART adherence can significantly enhance virologic suppression and reduce onward transmission of HIV and death among YLWH (8). Due to the high levels of ownership of mobile technologies (such as smartphones) among youth (9,10), digital health solutions are a potential mechanism to deliver interventions to improve HIV treatment outcomes among YLWH.…”

Section: Introductionmentioning

confidence: 99%

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Exploration of a Mobile Technology Vulnerability Scale’s association with antiretroviral adherence among young adults living with HIV in the United States

Saberi¹,

Eskaf²,

Campbell³

et al. 2022

mHealth

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Background: Young adults living with HIV (YLWH) have suboptimal adherence to antiretroviral therapy (ART) and HIV care outcomes. Mobile health technologies are increasingly used to deliver interventions to address HIV health outcomes. However, not all YLWH have equal and consistent access to mobile technologies.Methods: Using our novel Mobile Technology Vulnerability Scale (MTVS) to evaluate how vulnerable an individual feels with regard to their personal access to mobile technology in the past 6 months, we conducted a cross-sectional online survey with 271 YLWH (18-29 years) in the US to evaluate the relationships between MTVS and self-reported ART adherence.Results: Participants reported changes in phone numbers (25%), stolen (14%) or lost (22%) phones, and disconnections of phone service due to non-payment (39%) in the past 6 months. On a scale of 0 to 1 (0 having no mobile technology vulnerability and 1 having complete mobile technology vulnerability), participants had a mean MTVS of 0.33 (SD =0.26). Black and financially constrained participants had the highest MTVS, which was significantly higher that other racial/ethnic and financially non-constrained groups, respectively. Higher MTVS was significantly associated with ART non-adherence and nonpersistence.Conclusions: Findings suggest the need to measure MTVS to recognize pitfalls when using mobile health interventions and identify populations whose inconsistent mobile technology access may be related to worse health outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Exploration of a Mobile Technology Vulnerability Scale’s association with antiretroviral adherence among young adults living with HIV in the United States

Saberi¹,

Eskaf²,

Campbell³

et al. 2022

mHealth

View full text Add to dashboard Cite

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“…We developed the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)–Adolescent model to project life expectancy for 18-year-olds with and without HIV in the US. We simulated 3 age-matched, race-matched, and ethnicity-matched cohorts based on available national data reporting similar race and ethnicity distributions among youth with HIV: youth with PHIV, youth with NPHIV, and youth without HIV .…”

Section: Methodsmentioning

confidence: 99%

Projected Life Expectancy for Adolescents With HIV in the US

Neilan,

Ufio,

Brenner

et al. 2024

JAMA Health Forum

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ImportanceLife expectancy is a key measure of overall population health. Life expectancy estimates for youth with HIV in the US are needed in the current HIV care and treatment context to guide health policies and resource allocation.ObjectiveTo compare life expectancy between 18-year-old youth with perinatally acquired HIV (PHIV), youth with nonperinatally acquired HIV (NPHIV), and youth without HIV.Design, Setting, and ParticipantsUsing a US-focused adolescent-specific Monte Carlo state-transition HIV model, we simulated individuals from age 18 years until death. We estimated probabilities of HIV treatment and care engagement, HIV progression, clinical events, and mortality from observational cohorts and clinical trials for model input parameters. The simulated individuals were 18-year-old race and ethnicity–matched youth with PHIV, youth with NPHIV, and youth without HIV; 47%, 85%, and 50% were assigned male sex at birth, respectively. Individuals were categorized by US Centers for Disease Control and Prevention–defined HIV acquisition risk: men who have sex with men, people who ever injected drugs, heterosexually active individuals at increased risk for HIV infection, or average risk for HIV infection. Distributions were 3%, 2%, 12%, and 83% for youth with PHIV and youth without HIV, and 80%, 6%, 14%, and 0% for youth with NPHIV, respectively. Among the simulated youth in this analysis, individuals were 61% Black, 24% Hispanic, and 15% White, respectively.ExposuresHIV status by timing of acquisition.Main OutcomesLife expectancy loss for youth with PHIV and youth with NPHIV: difference between mean projected life expectancy under current and ideal HIV care scenarios compared with youth without HIV. Uncertainty intervals reflect varying adolescent HIV-related mortality inputs (95% CIs).ResultsCompared with youth without HIV (life expectancy: male, 76.3 years; female, 81.7 years), male youth with PHIV and youth with NPHIV had projected life expectancy losses of 10.4 years (95% CI, 5.5-18.1) and 15.0 years (95% CI, 9.3-26.8); female youth with PHIV and youth with NPHIV had projected life expectancy losses of 11.8 years (95% CI, 6.4-20.2) and 19.5 years (95% CI, 13.8-31.6), respectively. When receiving ideal HIV care, life expectancy losses were projected to improve for youth with PHIV (male: 0.5 years [95% CI, 0.3-1.8]: female: 0.6 years [95% CI, 0.4-2.1]) but were projected to persist for youth with NPHIV (male: 6.0 years [95% CI, 5.0-9.1]; female: 10.4 years [95% CI, 9.4-13.6]).ConclusionsThis adolescent-focused microsimulation modeling analysis projected that youth with HIV would have shorter life expectancy than youth without HIV. Projected differences were larger for youth with NPHIV compared with youth with PHIV. Differences in mortality by sex at birth, sexual behavior, and injection drug use contributed to lower projected life expectancy among youth with NPHIV. Interventions focused on HIV care and social factors are needed to improve life expectancy for youth with HIV in the US.

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Cost-Effectiveness of Anti-retroviral Adherence Interventions for People Living with HIV: A Systematic Review of Decision Analytical Models

Ahmed

Dujaili

Chuah

et al. 2023

Appl Health Econ Health Policy

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Background Although safe and effective anti-retrovirals (ARVs) are readily available, non-adherence to ARVs is highly prevalent among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLWHA). Different adherence-improving interventions have been developed and examined through decision analytic model-based health technology assessments. This systematic review aimed to review and appraise the decision analytical economic models developed to assess ARV adherence-improvement interventions. Methods The review protocol was registered on PROSPERO (CRD42022270039), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Relevant studies were identified through searches in six generic and specialized bibliographic databases, i.e. PubMed, Embase, NHS Economic Evaluation Database, PsycINFO, Health Economic Evaluations Database, tufts CEA registry and EconLit, from their inception to 23 October 2022. The cost-effectiveness of adherence interventions is represented by the incremental cost-effectiveness ratio (ICER). The quality of studies was assessed using the quality of the health economics studies (QHES) instrument. Data were narratively synthesized in the form of tables and texts. Due to the heterogeneity of the data, a permutation matrix was used for quantitative data synthesis rather than a meta-analysis. Results Fifteen studies, mostly conducted in North America (8/15 studies), were included in the review. The time horizon ranged from a year to a lifetime. Ten out of 15 studies used a micro-simulation, 4/15 studies employed Markov and 1/15 employed a dynamic model. The most commonly used interventions reported include technology based (5/15), nurse involved (2/15), directly observed therapy (2/15), case manager involved (1/15) and others that involved multi-component interventions (5/15). In 1/15 studies, interventions gained higher quality-adjusted life years (QALYs) with cost savings. The interventions in 14/15 studies were more effective but at a higher cost, and the overall ICER was well below the acceptable threshold mentioned in each study, indicating the interventions could potentially be implemented after careful interpretation. The studies were graded as high quality (13/15) or fair quality (2/15), with some methodological inconsistencies reported. Conclusion Counselling and smartphone-based interventions are cost-effective, and they have the potential to reduce the chronic adherence problem significantly. The quality of decision models can be improved by addressing inconsistencies in model selection, data inputs incorporated into models and uncertainty assessment methods. Supplementary Information The online version contains supplementary material available at 10.1007/s40258-023-00818-4.

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Modeling Adherence Interventions Among Youth with HIV in the United States: Clinical and Economic Projections

Cited by 7 publications

References 61 publications

Exploration of a Mobile Technology Vulnerability Scale’s association with antiretroviral adherence among young adults living with HIV in the United States

Exploration of a Mobile Technology Vulnerability Scale’s association with antiretroviral adherence among young adults living with HIV in the United States

Projected Life Expectancy for Adolescents With HIV in the US

Cost-Effectiveness of Anti-retroviral Adherence Interventions for People Living with HIV: A Systematic Review of Decision Analytical Models

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