Department of Operations, Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio.
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts.
AIDS. 2022 Jul 15;36(9):1223-1232. doi: 10.1097/QAD.0000000000003231. Epub 2022 Apr 26.
MSM in India are at a high risk for HIV infection given psychosocial challenges, sexual orientation stress, and stigma. We examined the cost-effectiveness of a novel resilience-based psychosocial intervention for MSM in India.
We parameterized a validated microsimulation model (CEPAC) with India-specific data and results from a randomized trial and examined two strategies for MSM: status quo HIV care ( SQ ), and a trial-based psychosocial intervention ( INT ) focused on building resilience to stress, improving mental health, and reducing condomless anal sex (CAS).
We projected lifetime clinical and economic outcomes for MSM without HIV initially. Intervention effectiveness, defined as reduction in self-reported CAS, was estimated at 38%; cost was $49.37/participant. We used a willingness-to-pay threshold of US$2100 (2019 Indian per capita GDP) per year of life saved (YLS) to define cost-effectiveness. We also assessed the 5-year budget impact of offering this intervention to 20% of Indian MSM.
Model projections showed the intervention would avert 2940 HIV infections among MSM over 10 years. Over a lifetime horizon, the intervention was cost-effective (ICER = $900/YLS). Results were most sensitive to intervention effectiveness and cost; the intervention remained cost-effective under plausible ranges of these parameters. Offering this intervention in the public sector would require an additional US$28 M over 5 years compared with SQ .
A resilience-based psychosocial intervention integrated with HIV risk reduction counseling among MSM in India would reduce HIV infections and be cost-effective. Programs using this approach should be expanded as a part of comprehensive HIV prevention in India.
鉴于印度男男性行为者（MSM）面临的心理社会挑战、性取向压力和耻辱感，他们感染艾滋病毒的风险很高。我们研究了一种针对印度 MSM 的新型基于恢复力的心理社会干预措施的成本效益。
我们使用印度特定数据和一项随机试验的结果对经过验证的微观模拟模型（CEPAC）进行了参数化，并对两种 MSM 策略进行了研究：现状艾滋病毒护理（SQ）和以建立对压力的恢复力、改善心理健康和减少无保护肛交（CAS）为重点的基于试验的心理社会干预（INT）。
我们首先对没有艾滋病毒的 MSM 进行了终生临床和经济结果预测。干预效果的定义是自我报告的 CAS 减少，估计为 38%；成本为 49.37 美元/参与者。我们使用 2100 美元（2019 年印度人均 GDP）作为每年挽救的生命年（YLS）的支付意愿阈值来定义成本效益。我们还评估了向 20%的印度 MSM 提供这种干预措施的 5 年预算影响。
模型预测显示，该干预措施将在 10 年内避免 2940 例 MSM 感染艾滋病毒。从终生角度来看，该干预措施具有成本效益（ICER=900 美元/YLS）。结果对干预效果和成本最为敏感；在这些参数的合理范围内，干预仍然具有成本效益。与 SQ 相比，在公共部门提供这种干预措施将需要额外的 2800 万美元，为期 5 年。
在印度，将基于恢复力的心理社会干预与艾滋病毒风险降低咨询相结合，将减少艾滋病毒感染，具有成本效益。作为印度全面艾滋病毒预防工作的一部分，应扩大采用这种方法的项目。
