In the current report, we ask if targeting a cognitive
behavioral therapy (CBT)-based intervention aimed at reducing hazardous alcohol
consumption to HIV-infected persons in
East Africa would have a favorable value at costs that are feasible for
scale-up.
Using a computer simulation to inform HIV prevention
decisions in East Africa, we compared 4 different strategies for targeting a
CBT intervention-(i) all HIV-infected persons attending
clinic; (ii) only those patients in the pre-antiretroviral therapy (ART) stages
of care; (iii) only those patients receiving ART; and (iv) only those patients
with detectable viral loads (VLs) regardless of disease stage. We define targeting
as screening for hazardous alcohol consumption (e.g., using the Alcohol Use
Disorders Identification Test and offering the CBT intervention to those who
screen positive). We compared these targeting strategies to a null strategy (no
intervention) or a hypothetical scenario where an alcohol intervention was
delivered to all adults regardless of HIV status.
An intervention targeted to HIV-infected patients could
prevent 18,000 new infections, add 46,000 quality-adjusted life years (QALYs), and
yield an incremental cost-effectiveness ratio of $600/QALY compared to the null
scenario. Narrowing the prioritized population to only HIV-infected patients in
pre-ART phases of care results in 15,000 infections averted, the addition of
21,000 QALYs and would be cost-saving, while prioritizing based on an
unsuppressed HIV-1 VL test results in 8,300 new infections averted, adds 6,000
additional QALYs, and would be cost-saving as well.
Our results suggest that targeting a cognitive-based treatment
aimed at reducing hazardous alcohol consumption to subgroups of HIV-infected
patients provides favorable value in comparison with other beneficial
strategies for HIV prevention and control in this region. It may even be
cost-saving under certain circumstances.
Full article at:
By:
- 1Department of Population Health, NYU School of Medicine, New York, New York.
- 2Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
- 3Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
- 4National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.
More at: https://twitter.com/hiv_insight
No comments:
Post a Comment