Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina.
Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
J Adolesc Health. 2024 Nov;75(5):709-724. doi: 10.1016/j.jadohealth.2024.06.013. Epub 2024 Aug 13.
Young people living with HIV (YPLWH) face the burden of navigating the unique physical, psychological, and social challenges of adolescence while coping with a stigmatized infectious disease that requires lifelong care. Consequently, YPLWH experience worse HIV outcomes compared to children and adults. This systematic review seeks to collate evidence on the health and economic impact of HIV interventions targeting YPLWH and to identify gaps in the available evidence that may inform future economic evaluations of interventions for YPLWH.
We searched the MEDLINE, Embase, Scopus, and Global Index Medicus databases for peer-reviewed articles published through April 24, 2022 (PROSPERO ID: CRD42022356244). Our inclusion criteria encompassed economic evaluations of HIV interventions that report health and economic outcomes among individuals ages 10-24 years. Three investigators screened articles at the title, abstract, and full-text levels. The data were extracted in accordance with the Consolidated Health Economic Evaluation Reporting Standards 2022.
Of the 3,735 unique articles retrieved through our search, 32 met our inclusion criteria. Of these 32 articles, 8 (25%) evaluated a behavioral, educational, or financial intervention, 6 (19%) voluntary medical male circumcision, 5 (16%) HIV screening or testing, 4 (13%) pre-exposure prophylaxis, 3 (9%) a hypothetical HIV vaccine, 2 (6%) antiretroviral therapy, 1 (3%) condom distribution, and 3 (9%) a combination of interventions. Twenty-two studies (69%) focused on Africa, 9 (28%) on North America, and 1 (3%) on Europe. Thirty studies (94%) were cost-effectiveness analyses and 2 (6%) were cost-utility analyses. Of the intervention types captured by this review, most were deemed cost-saving or cost-effective. Only two studies-one evaluating a financial intervention and one evaluating HIV testing-concluded that the intervention was not cost-effective.
Evidence presented by this review suggests that investments in HIV prevention and treatment for young people can be a cost-effective, and sometimes cost-saving, solution to combating the global HIV epidemic. However, additional evaluations of HIV interventions targeting young people, which adhere to standardized reporting practices, are needed to permit comparability of cost-effectiveness outcomes between interventions and settings.
感染艾滋病毒的年轻人（YPLWH）在应对与终生护理相关的污名化传染病的同时，还要承受青春期独特的身心和社会挑战，这使他们面临着更大的负担。因此，与儿童和成年人相比，YPLWH 的艾滋病毒结局更差。本系统评价旨在收集针对 YPLWH 的艾滋病毒干预措施的健康和经济影响的证据，并确定现有证据中的空白，以指导未来针对 YPLWH 的干预措施的经济评估。
我们在 MEDLINE、Embase、Scopus 和全球索引医学数据库中搜索了截至 2022 年 4 月 24 日发表的同行评议文章（PROSPERO ID：CRD42022356244）。我们的纳入标准包括报告 10-24 岁个体健康和经济结局的艾滋病毒干预措施的经济评估。三名研究人员在标题、摘要和全文层面筛选文章。按照 2022 年健康经济评估报告标准提取数据。
在我们的搜索中，从 3735 篇独特的文章中，有 32 篇符合我们的纳入标准。这 32 篇文章中，有 8 篇（25%）评估了行为、教育或财政干预措施，6 篇（19%）评估了自愿男性包皮环切术，5 篇（16%）评估了艾滋病毒筛查或检测，4 篇（13%）评估了暴露前预防，3 篇（9%）评估了假设性艾滋病毒疫苗，2 篇（6%）评估了抗逆转录病毒疗法，1 篇（3%）评估了避孕套分发，3 篇（9%）评估了干预措施的组合。22 项研究（69%）集中在非洲，9 项（28%）在北美，1 项（3%）在欧洲。30 项研究（94%）为成本效益分析，2 项（6%）为成本效用分析。在本综述中所涵盖的干预类型中，大多数被认为是节省成本或具有成本效益。只有两项研究——一项评估财政干预措施，另一项评估艾滋病毒检测——得出干预措施不具有成本效益的结论。
本综述提供的证据表明，对年轻人的艾滋病毒预防和治疗进行投资，可以成为一种具有成本效益的、有时甚至是节省成本的解决方案，以应对全球艾滋病毒流行。然而，需要更多遵循标准化报告实践的针对年轻人的艾滋病毒干预措施的评估，以便在干预措施和环境之间比较成本效益结果的可比性。
