Fan Rui-Qi, Shu Jun-Tao, Huang Hao, Shi Ling-Yi, Ge Qi-Wei, Zhuang Xun, Zou Mei-Yin, Qin Gang
Department of Infectious Diseases, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, JS, China.
Department of Epidemiology and Biostatistics, School of Public Health of Nantong University, Nantong, JS, China.
BMC Public Health. 2024 Dec 20;24(1):3553. doi: 10.1186/s12889-024-20857-3.
BACKGROUND: Men who have sex with men (MSM) globally face a high risk of HIV infection. Previous studies indicate that customized short message service (SMS) interventions could reduce high-risk behaviors that associated with HIV transmission. This study aims to evaluate the health and economic impacts of such interventions among MSM in China. METHODS: A decision tree-Markov model was developed for a simulated cohort of 100,000 MSM of 20 years old. We assessed three intervention strategies: (1) routine strategy with standard health information; (2) SMS strategy with customized messages based on individual high-risk behaviors, with 50.1% efficacy and 50% coverage; (3) LEN-LA (lenacapavir long-acting) strategy as pre-exposure prophylaxis (PrEP), with 100% efficacy lasting for 0.5-year and 50% coverage. The study period was 45 years. Primary outcomes included the number of HIV infections and HIV-related deaths. The cost-effectiveness, cost-utility and cost-benefit analyses were conducted along with sensitivity analyses from the healthcare sector perspective. RESULTS: The SMS strategy was more effective, averting 6,191 (22.0%) HIV infections and 2,100 (38.5%) HIV-related deaths when compared with routine strategy. The average cost-effectiveness ratios (ACERs) were US$6,361 (95% CI: 5,959-6,613) per HIV infection averted and US$18,752 (95% CI: 17,274 - 20,530) per HIV-related death averted. It had incremental cost-effectiveness ratios (ICERs) of US$1,743 (95% CI: 1,673-1,799) per QALY, with a benefit cost ratio (BCR) of 1.98 (95% CI: 1.94-2.02), compared with routine strategy. While the LEN-LA strategy may be the most effective, its high cost, coupled with the highest ICER, currently presents a considerable obstacle to its widespread adoption. The ICERs were most affected by the probability of HIV infection, intervention cost and coverage. CONCLUSIONS: SMS strategy for preventing HIV among MSM in China is cost-effective and could be a promising strategy for HIV prevention. These findings may have implications for public health policy and resource allocation in HIV prevention efforts targeting high-risk populations.
背景：全球男男性行为者（MSM）面临着较高的艾滋病毒感染风险。以往研究表明，定制的短信服务（SMS）干预措施可减少与艾滋病毒传播相关的高危行为。本研究旨在评估此类干预措施对中国男男性行为者的健康和经济影响。 方法：为一个由100,000名20岁男男性行为者组成的模拟队列建立了决策树-马尔可夫模型。我们评估了三种干预策略：（1）提供标准健康信息的常规策略；（2）基于个体高危行为定制信息的短信策略，有效率为50.1%，覆盖率为50%；（3）作为暴露前预防（PrEP）的长效注射用莱纳卡韦（LEN-LA）策略，有效率为100%，持续0.5年，覆盖率为50%。研究期为45年。主要结局包括艾滋病毒感染数和与艾滋病毒相关的死亡数。从医疗保健部门的角度进行了成本效益、成本效用和成本效益分析以及敏感性分析。 结果：与常规策略相比，短信策略更有效，可避免6,191例（22.0%）艾滋病毒感染和2,100例（38.5%）与艾滋病毒相关的死亡。每避免一例艾滋病毒感染的平均成本效益比（ACER）为6,361美元（95%置信区间：5,959 - 6,613美元），每避免一例与艾滋病毒相关的死亡的平均成本效益比为18,752美元（95%置信区间：17,274 - 20,530美元）。与常规策略相比，其每质量调整生命年（QALY）的增量成本效益比（ICER）为1,743美元（95%置信区间：1,673 - 1,799美元），效益成本比（BCR）为1.98（95%置信区间：1.94 - 2.02）。虽然LEN-LA策略可能是最有效的，但其高成本，再加上最高的ICER，目前是其广泛应用的一个重大障碍。ICER受艾滋病毒感染概率、干预成本和覆盖率的影响最大。 结论：在中国男男性行为者中预防艾滋病毒的短信策略具有成本效益，可能是一种有前景的艾滋病毒预防策略。这些发现可能对针对高危人群的艾滋病毒预防工作中的公共卫生政策和资源分配产生影响。
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