INTRODUCTION: We used a computer simulation of HIV progression and transmission to evaluate the cost-effectiveness of a scale-up of three strategies to seek out and test individuals with undiagnosed HIV in New York City (NYC).
SETTING: Hypothetical NYC population.
METHODS: We incorporated the observed effects and costs of the three “seek and test” strategies in a computer simulation of HIV in NYC, comparing a scenario in which the strategies were scaled up with a one-year implementation or a long-term implementation with a counterfactual scenario with no scale-up. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, calibrated to NYC epidemiological data from 2003 to 2015. The three approaches were respondent driven sampling (RDS) with anonymous HIV testing (“RDS-A”), RDS with a two-session confidential HIV testing approach (“RDS-C”), and venue-based sampling (“VBS”).
RESULTS: RDS-A was the most cost-effective strategy tested. When implemented for only one year and then stopped thereafter, using a societal perspective, the cost per quality-adjusted life-year (QALY) gained versus no intervention was $812/QALY, $18,110/QALY, and $20,362/QALY for RDS-A, RDS-C, and VBS, respectively. When interventions were implemented long-term, the cost per QALY gained versus no intervention was cost-saving, $31,773/QALY, and $35,148/QALY for RDS-A, RDS-C, and VBS, respectively. When compared to RDS-A the incremental cost effectiveness ratios (ICERs) for both VBS and RDS-C were dominated.
CONCLUSION: The expansion of the RDS-A strategy would substantially reduce HIV-related deaths and new HIV infections in NYC, and would be either cost-saving or have favorable cost-effectiveness.
Cost-effectiveness of peer- versus venue-based approaches for detecting undiagnosed HIV among heterosexuals in high-risk New York City neighborhoods
Journal of Acquired Immune Deficiency Syndromes, 77 (2), 183-192. doi: 10.1097/QAI.0000000000001578. PMCID: PMC5762425.