Effectiveness and Cost Effectiveness of Expanding Harm Reduction and Antiretroviral Therapy in a Mixed HIV Epidemic A Modeling Analysis for Ukraine 英文参考文献.docVIP

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Effectiveness and Cost Effectiveness of Expanding Harm Reduction and Antiretroviral Therapy in a Mixed HIV Epidemic A Modeling Analysis for Ukraine 英文参考文献.doc

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Effectiveness and Cost Effectiveness of Expanding Harm Reduction and Antiretroviral Therapy in a Mixed HIV Epidemic A Modeling Analysis for Ukraine 英文参考文献

EffectivenessandCostEffectivenessofExpandingHarm ReductionandAntiretroviralTherapyinaMixedHIV Epidemic:AModelingAnalysisforUkraine SabinaS.Alistar1*,DouglasK.Owens2,3,MargaretL.Brandeau1 1Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America, 2Veterans Affairs Palo Alto Health Care System,PaloAlto,California,UnitedStatesofAmerica,3CenterforHealthPolicyandtheCenterforPrimaryCareandOutcomesResearch,StanfordUniversity,Stanford, California,UnitedStatesofAmerica Abstract Background: Injection drug use (IDU) and heterosexual virus transmission both contribute to the growing mixed HIV epidemicsinEasternEuropeandCentralAsia.InUkraine—choseninthisstudyasarepresentativecountry—IDU-relatedrisk behaviorscausehalfofnewinfections,butfewinjectiondrugusers(IDUs)receivemethadonesubstitutiontherapy.Only 10%ofeligibleindividualsreceiveantiretroviraltherapy(ART).Theappropriateresourceallocationbetweentheseprograms has not been studied. We estimated the effectiveness and cost-effectiveness of strategies for expanding methadone substitutiontherapyprogramsandARTinmixedHIVepidemics,usingUkraineasacasestudy. MethodsandFindings:WedevelopedadynamiccompartmentalmodeloftheHIVepidemicinapopulationofnon-IDUs, IDUsusingopiates,andIDUsonmethadonesubstitutiontherapy,stratifiedbyHIVstatus,andpopulateditwithdatafrom theUkraine.Weconsideredinterventionsexpandingmethadonesubstitutiontherapy,increasingaccesstoART,orboth.We measuredhealthcarecosts,quality-adjustedlifeyears(QALYs),HIVprevalence,infectionsaverted,andincrementalcost- effectiveness.Withoutincrementalinterventions,HIVprevalencereached67.2%(IDUs)and0.88%(non-IDUs)after20years. Offeringmethadonesubstitutiontherapyto25%ofIDUsreducedprevalencemosteffectively(to53.1%IDUs,0.80%non- IDUs),andwasmostcost-effective,averting4,700infectionsandadding76,000QALYscomparedwithnointerventionat US$530/QALY gained. Expanding both ART (80% coverage of those eligible for ART according to WHO criteri