ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2016
The Epidemiologic and Economic Impact of Improving HIV Testing, Linkage, and Retention in Care in the United States.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
57 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Systematic Review and Meta-analysis of Linkage to HIV Care Interventions in the United States, Canada, and Ukraine (2010-2021).AIDS and behavior · 2023Pooled it
- Cost-Effectiveness of HIV Retention and Re-engagement Interventions in High-Income Countries: A Systematic Literature Review.AIDS and behavior · 2022Pooled it
- Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review.AIDS and behavior · 2017Pooled it
- Predicting organizational readiness to implement HIV prevention with couples using practitioners' intentions: testing a heuristic.Translational behavioral medicine · 2020Trial
- Aligning definitions with realities: a qualitative study on the complexities of measuring retention in HIV care in the global context.BMJ open · 2026Article
- The HIV Epidemic in the United States - Epidemiological Projections and Public Economic Impact of Achieving Zero Transmission Goals.ClinicoEconomics and outcomes research : CEOR · 2025Article
- A Digital Health Intervention on Healthy Behaviors Among Men Who Have Sex with Men in China Based on Information-Motivation-Behavioral Skills Model: An Exploratory Real-World Study.International journal of sexual health : official journal of the World Association for Sexual Health · 2025Article
- National HIV and HCV Screening Rates for Hospitalized People who Use Drugs Are Suboptimal and Heterogeneous Across 11 US Hospitals.Open forum infectious diseases · 2024Article
- Evaluation of an HIV homecare program for lost-to-follow-up populations: a mixed methods study in Detroit, Michigan.AIDS research and therapy · 2024Article
- Understanding effective post-test linkage strategies for HIV prevention and care: a scoping review.Journal of the International AIDS Society · 2024Article
- Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study.BMC health services research · 2024Article
- Relationships Between Patient Race and Residential Race Context With Missed Human Immunodeficiency Virus Care Visits in the United States, 2010-2015.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- A qualitative inquiry into the patient-related barriers to linkage and retention in HIV care within the community setting.Exploratory research in clinical and social pharmacy · 2023Article
- Financing Benefits and Barriers to Routine HIV Screening in Clinical Settings in the United States: A Scoping Review.International journal of environmental research and public health · 2022Article
- A Cost-effectiveness Analysis of a Mobile Phone-Based Integrated HIV-Prevention Intervention Among Men Who Have Sex With Men in China: Economic Evaluation.Journal of medical Internet research · 2022Article
- Flow-Cytometry Intracellular Detection and Quantification of HIV1 p24 Antigen and Immunocheckpoint Molecules in T Cells among HIV/AIDS Patients.HIV/AIDS (Auckland, N.Z.) · 2022Article
- Treatment Outcomes of HIV Infected Children After Initiation of Antiretroviral Therapy in Southwest China: An Observational Cohort Study.Frontiers in pediatrics · 2022Article
- Patients, Social Workers, and Pharmacists' Perceptions of Barriers to Providing HIV Care in Community Pharmacies in the United States.Pharmacy (Basel, Switzerland) · 2021Article
- What Will It Take to End HIV in the United States? : A Comprehensive, Local-Level Modeling Study.Annals of internal medicine · 2021Article
- Outcomes and costs of publicly funded patient navigation interventions to enhance HIV care continuum outcomes in the United States: A before-and-after study.PLoS medicine · 2021Article
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Authors and funding
4 authors.
Funding
Abstract
backgroundRecent guidelines advocate early antiretroviral therapy (ART) to decrease human immunodeficiency virus (HIV) morbidity and prevent transmission, but suboptimal engagement in care may compromise impact. We sought to determine the economic and epidemiologic impact of incomplete engagement in HIV care in the United States.
methodsWe constructed a dynamic transmission model of HIV among US adults (aged 15-65 years) and conducted a cost-effectiveness analysis of improvements along the HIV care continuum : We evaluated enhanced HIV testing (annual for high-risk groups), increased 3-month linkage to care (to 90%), and improved retention (50% relative reduction in yearly disengagement and 50% increase in reengagement). Our primary outcomes were HIV incidence, mortality, costs and quality-adjusted life-years (QALYs).
resultsDespite early ART initiation, a projected 1.39 million (95% uncertainty range [UR], 0.91-2.2 million) new HIV infections will occur at a (discounted) cost of $256 billion ($199-298 billion) over 2 decades at existing levels of HIV care engagement. Enhanced testing with increased linkage has modest epidemiologic benefits and could reduce incident HIV infections by 21% (95% UR, 13%-26%) at a cost of $65 700 per QALY gained ($44 500-111 000). By contrast, comprehensive improvements that couples enhanced testing and linkage with improved retention would reduce HIV incidence by 54% (95% UR, 37%-68%) and mortality rate by 64% (46%-78%), at a cost-effectiveness ratio of $45 300 per QALY gained ($27 800-72 300).
conclusionsFailure to improve engagement in HIV care in the United States leads to excess infections, treatment costs, and deaths. Interventions that improve not just HIV screening but also retention in care are needed to optimize epidemiologic impact and cost-effectiveness.
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