Averting HIV Infections in New York City A Modeling Approach Estimating the Future Impact of Additional Behavioral and Biomedical HIV Prevention Strategies.docVIP

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Averting HIV Infections in New York City A Modeling Approach Estimating the Future Impact of Additional Behavioral and Biomedical HIV Prevention Strategies.doc

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Averting HIV Infections in New York City A Modeling Approach Estimating the Future Impact of Additional Behavioral and Biomedical HIV Prevention Strategies

AvertingHIVInfectionsinNewYorkCity:AModeling ApproachEstimatingtheFutureImpactofAdditional BehavioralandBiomedicalHIVPreventionStrategies JasonKessler1*,JulieE.Myers2,3,KimberlyA.Nucifora1,NanaMensah2,AlexisKowalski1, MonicaSweeney2,ChristopherToohey1,AminKhademi4,ColinShepard2,BlayneCutler2, R.ScottBraithwaite1 1DivisionofComparativeEffectivenessandDecisionScience,DepartmentofPopulationHealth,NewYorkUniversitySchoolofMedicine,NewYork,NewYork,United StatesofAmerica,2BureauofHIV/AIDSPreventionandControl,NewYorkCityDepartmentofHealthandMentalHygiene,NewYork,NewYork,UnitedStatesofAmerica, 3DivisionofInfectiousDiseases,ColumbiaUniversityMedicalCenter,NewYork,NewYork,UnitedStatesofAmerica,4DepartmentofIndustrialEngineering,Universityof Pittsburgh,Pittsburgh,Pennsylvania,UnitedStatesofAmerica Abstract Background: New York City (NYC) remains an epicenter of the HIV epidemic in the United States. Given the variety of evidence-based HIV prevention strategies available and the significant resources required to implement each of them, comparativestudiesareneededtoidentifyhowtomaximizethenumberofHIVcasespreventedmosteconomically. Methods: A new model of HIV disease transmission was developed integrating information from a previously validated micro-simulationHIVdiseaseprogressionmodel.Specificationandparameterizationofthemodelanditsinputs,including the intervention portfolio, intervention effects and costs were conducted through a collaborative process between the academic modeling team and the NYC Department of Health and Mental Hygiene. The model projects the impact of differentpreventionstrategies,orportfoliosofpreventionstrategies,ontheHIVepidemicinNYC. Results: Ten unique interventions were able to provide a prevention benefit at an annual program cost of less than $360,000,thethresholdforconsideration asacost-savingintervention(becauseof offsetsbyfuture HIVtreatmentcosts averted).Anoptimizedportfolioofthesespecificinterventionscouldresultinuptoa34%reductioninnewHIV