Nosyk Bohdan, Min Jeong Eun, Zang Xiao, Feaster Daniel J, Metsch Lisa, Marshall Brandon D L, Rio Carlos Del, Granich Reuben, Schackman Bruce R, Montaner Julio S G
1 BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
2 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
J Int Assoc Provid AIDS Care. 2019 Jan-Dec;18:2325958218821962. doi: 10.1177/2325958218821962.
With efficacious behavioral, biomedical, and structural interventions available, combination implementation strategies are being implemented to combat HIV/AIDS across settings internationally. However, priority statements from national and international bodies make it unclear whether the objective should be the reduction in HIV incidence or the maximization of health, most commonly measured with quality-adjusted life years (QALYs). Building off a model-based evaluation of HIV care interventions in British Columbia, Canada, we compare the optimal sets of interventions that would be identified using HIV infections averted, and QALYs as the primary outcome in a cost-effectiveness analysis. We found an explicit focus on averting new infections undervalues the health benefits derived from antiretroviral therapy, resulting in suboptimal and potentially harmful funding recommendations.
鉴于现有的有效行为、生物医学和结构性干预措施，国际上正在跨环境实施联合实施策略以抗击艾滋病毒/艾滋病。然而，国家和国际机构的优先声明并未明确目标应该是降低艾滋病毒发病率还是实现健康最大化（最常用质量调整生命年（QALYs）来衡量）。基于对加拿大不列颠哥伦比亚省艾滋病毒护理干预措施的基于模型的评估，我们比较了在成本效益分析中使用避免的艾滋病毒感染和QALYs作为主要结果所确定的最佳干预措施组合。我们发现，明确侧重于避免新感染会低估抗逆转录病毒疗法带来的健康益处，从而导致次优且可能有害的资金建议。
