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

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

doi:10.1007/s10461-021-03169-0

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

AIDS Behav. 2021 Sep;25(9):2973-2984. doi: 10.1007/s10461-021-03169-0. Epub 2021 Feb 6.

Authors

Anne M Neilan^{1

2

3

4}, Audrey C Bangs⁵, Michael Hudgens⁶, Kunjal Patel⁷, Allison L Agwu⁸, Ingrid V Bassett^{9

5

10

11}, Aditya H Gaur¹², Emily P Hyle^{9

5

10

11}, Catherine M Crespi¹³, Keith J Horvath¹⁴, Caitlin M Dugdale^{9

5}, Kimberly A Powers¹⁵, H Jonathon Rendina¹⁶, Milton C Weinstein¹⁷, Rochelle P Walensky^{9

5

10

11}, Kenneth A Freedberg^{9

5

10

11

18}, Andrea L Ciaranello^{9

5

10

11}

Affiliations

¹ Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA. aneilan@mgh.harvard.edu.
² Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. aneilan@mgh.harvard.edu.
³ Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA. aneilan@mgh.harvard.edu.
⁴ Harvard Medical School, Boston, MA, USA. aneilan@mgh.harvard.edu.
⁵ Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
⁶ Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Department of Epidemiology and Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁸ Department of Pediatrics and Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁹ Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Harvard Medical School, Boston, MA, USA.
¹¹ Harvard University Center for AIDS Research, Cambridge, MA, USA.
¹² St. Jude's Children's Research Hospital, Memphis, TN, USA.
¹³ Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
¹⁴ Department of Psychology, San Diego State University, San Diego, CA, USA.
¹⁵ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁶ Department of Psychology, Hunter College of the City University of New York, New York, NY, USA.
¹⁷ Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁸ Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

Abstract
in English, Spanish

The Adolescent Medicine Trials Network for HIV/AIDS Interventions is evaluating treatment adherence interventions (AI) to improve virologic suppression (VS) among youth with HIV (YWH). Using a microsimulation model, we compared two strategies: standard-of-care (SOC) and a hypothetical 12-month AI that increased cohort-level VS in YWH in care by an absolute ten percentage points and cost $100/month/person. Projected outcomes included primary HIV transmissions, deaths and life-expectancy, lifetime HIV-related costs, and incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year [QALY]). Compared to SOC, AI would reduce HIV transmissions by 15% and deaths by 12% at 12 months. AI would improve discounted life expectancy/person by 8 months at an added lifetime cost/person of $5,300, resulting in an ICER of $7,900/QALY. AI would be cost-effective at $2,000/month/person or with efficacies as low as a 1 percentage point increase in VS. YWH-targeted adherence interventions with even modest efficacy could improve life expectancy, prevent onward HIV transmissions, and be cost-effective.

La Red de Ensayos Médicos sobre Adolescentes para Realizar Intervenciones sobre el VIH/SIDA está evaluando intervenciones de adherencia (IAs) al tratamiento para mejorar la supresión virológica (SV) entre los jóvenes con VIH (JCV). Usando un modelo de microsimulación, comparamos dos estrategias: cuidado convencional (CC) y una intervención de adherencia hipotética durando 12 meses que aumentaría la SV a nivel de cohorte entre JCV en tratamiento por 10 puntos de porcentuales y que costaría US$ 100/mes/persona. Resultados proyectados incluyeron transmisiones de VIH primarias, muertes y esperanza de vida, costos de por vida asociados con el VIH, y razones incrementales de costo-efectividad (RICEs, $/año de vida ajustado por la calidad [AVAC]). Comparado al CC, la IA reduciría transmisiones de VIH por 15% y muertes por 12% a los 12 meses. La IA mejoraría esperanza de vida descontada/persona por 8 meses a un costo de por vida adicional/persona de US$ 5.300, resultando en una RICE de US$ 7.900/AVAC. La IA sería costo-efectiva a un costo de US$ 2.000/mes/persona o si mejorara SV por al menos un punto porcentual. Intervenciones de adherencia dirigidas a jóvenes con una eficacia incluso modesta podrían mejorar esperanza de vida, prevenir transmisiones de VIH, y ser costo-efectivas.

Keywords: Adherence; Adolescents; Cost-effectiveness; HIV; Intervention; Modeling; Young adults.

MeSH terms

Adolescent
Cost-Benefit Analysis
HIV Infections* / drug therapy
HIV Infections* / prevention & control
Humans
Quality-Adjusted Life Years
United States / epidemiology

Abstract in English, Spanish

MeSH terms

Grants and funding

Abstract
in English, Spanish