A Decision Analytics Model to Optimize Investment in Interventions Targeting the HIV PrEP Cascade of Care
ABSTRACT Objectives Gaps between recommended and actual levels of HIV preexposure prophylaxis (PrEP) use remain among men who have sex with men (MSM). Interventions can address these gaps, but it is unknown how public health initiatives should invest prevention funds into these interventions to maximize their population impact.Design We used a stochastic network-based HIV transmission model for MSM in the Atlanta area paired with an economic budget optimization model.Methods The model simulated MSM participating in up to three real-world PrEP cascade interventions designed to improve initiation, adherence, or persistence. The primary outcome was infections averted over 10 years. The budget optimization model identified the investment combination under different budgets that maximized this outcome given intervention costs from a payer perspective.Results From the base 15% PrEP coverage level, the three interventions could increase coverage to 27%, resulting in 12.3% of infections averted over 10 years. Uptake of each intervention was interdependent: maximal use of the adherence and persistence interventions depended on new PrEP users generated by the initiation intervention. As the budget increased, optimal investment involved a mixture of the initiation and persistence interventions, but not the adherence intervention. If adherence intervention costs were halved, the optimal investment was roughly equal across interventions.Conclusions Investments into the PrEP cascade through initiatives should account for the interactions of the interventions as they are collectively deployed. Given current intervention efficacy estimates, the total population impact of each intervention may be improved with greater total budgets or reduced intervention costs..
| Medienart: |
|
|---|
Preprint| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
bioRxiv.org - (2023) vom: 15. Okt. Zur Gesamtaufnahme - year:2023 |
|---|
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Jenness, Samuel M. [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| doi: |
10.1101/2020.12.10.20247270 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
XBI019528949 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | XBI019528949 | ||
| 003 | DE-627 | ||
| 005 | 20231205150426.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 201214s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1101/2020.12.10.20247270 |2 doi | |
| 035 | |a (DE-627)XBI019528949 | ||
| 035 | |a (biorXiv)10.1101/2020.12.10.20247270 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Jenness, Samuel M. |e verfasserin |0 (orcid)0000-0001-8840-105X |4 aut | |
| 245 | 1 | 0 | |a A Decision Analytics Model to Optimize Investment in Interventions Targeting the HIV PrEP Cascade of Care |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 520 | |a ABSTRACT Objectives Gaps between recommended and actual levels of HIV preexposure prophylaxis (PrEP) use remain among men who have sex with men (MSM). Interventions can address these gaps, but it is unknown how public health initiatives should invest prevention funds into these interventions to maximize their population impact.Design We used a stochastic network-based HIV transmission model for MSM in the Atlanta area paired with an economic budget optimization model.Methods The model simulated MSM participating in up to three real-world PrEP cascade interventions designed to improve initiation, adherence, or persistence. The primary outcome was infections averted over 10 years. The budget optimization model identified the investment combination under different budgets that maximized this outcome given intervention costs from a payer perspective.Results From the base 15% PrEP coverage level, the three interventions could increase coverage to 27%, resulting in 12.3% of infections averted over 10 years. Uptake of each intervention was interdependent: maximal use of the adherence and persistence interventions depended on new PrEP users generated by the initiation intervention. As the budget increased, optimal investment involved a mixture of the initiation and persistence interventions, but not the adherence intervention. If adherence intervention costs were halved, the optimal investment was roughly equal across interventions.Conclusions Investments into the PrEP cascade through initiatives should account for the interactions of the interventions as they are collectively deployed. Given current intervention efficacy estimates, the total population impact of each intervention may be improved with greater total budgets or reduced intervention costs. | ||
| 650 | 4 | |a Biology |7 (dpeaa)DE-84 | |
| 650 | 4 | |a 570 |7 (dpeaa)DE-84 | |
| 700 | 1 | |a Knowlton, Gregory |4 aut | |
| 700 | 1 | |a Smith, Dawn K. |4 aut | |
| 700 | 1 | |a Marcus, Julia L. |0 (orcid)0000-0002-8552-414X |4 aut | |
| 700 | 1 | |a Anderson, Emeli J. |0 (orcid)0000-0001-5218-1390 |4 aut | |
| 700 | 1 | |a Siegler, Aaron J. |0 (orcid)0000-0001-5553-7540 |4 aut | |
| 700 | 1 | |a Jones, Jeb |0 (orcid)0000-0001-9165-1658 |4 aut | |
| 700 | 1 | |a Sullivan, Patrick S. |0 (orcid)0000-0002-7728-0587 |4 aut | |
| 700 | 1 | |a Enns, Eva |0 (orcid)0000-0003-0693-7358 |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t bioRxiv.org |g (2023) vom: 15. Okt. |
| 773 | 1 | 8 | |g year:2023 |g day:15 |g month:10 |
| 856 | 4 | 0 | |u https://doi.org/10.1097/qad.0000000000002909 |z lizenzpflichtig |3 Volltext |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1101/2020.12.10.20247270 |z kostenfrei |3 Volltext |
| 912 | |a GBV_XBI | ||
| 951 | |a AR | ||
| 952 | |j 2023 |b 15 |c 10 | ||