Evidence map›Paper›PMID 34370977›Full record

ArticleThe lancet. HIV2021

Improving health equity and ending the HIV epidemic in the USA: a distributional cost-effectiveness analysis in six cities.

Amanda My Linh Quan, Cassandra Mah, Emanuel Krebs, Xiao Zang, Siyuan Chen, Keri Althoff, Wendy Armstrong, Czarina Navos Behrends, Julia C Dombrowski, Eva Enns and 13 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The lancet. HIV, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Challenges and Limitations in Distributional Cost-Effectiveness Analysis: A Systematic Literature Review.International journal of environmental research and public health · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Amanda My Linh QuanDalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Cassandra MahFaculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Emanuel KrebsFaculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
Xiao ZangFaculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
Siyuan ChenFaculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Keri AlthoffDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Wendy ArmstrongDivision of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Czarina Navos BehrendsDepartment of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
Julia C DombrowskiDepartment of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA.
Eva EnnsDivision of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
Daniel J FeasterDepartment of Public Health Sciences, Leonard M Miller School of Medicine, University of Miami, Miami, FL, USA.
Kelly A GeboBloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
William C GoedelDepartment of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
Matthew GoldenDepartment of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA; HIV/STD Program, Public Health-Seattle & King County, Seattle, WA, USA.
Brandon D L MarshallDepartment of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
Shruti H MehtaBloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Ankur PandyaT H Chan School of Public Health, Harvard University, Boston, MA, USA.
Bruce R SchackmanDepartment of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
Steffanie A StrathdeeSchool of Medicine, University of California San Diego, La Jolla, CA, USA.
Patrick SullivanDepartment of Epidemiology, Emory University, Atlanta, GA, USA.
Hansel TookesDepartment of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Bohdan NosykFaculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. Electronic address: bnosyk@sfu.ca.
Localized HIV Economic Modeling Study Group

Funding

Localized economic modeling to support implementation of the Ending the HIV Epidemic initiativeR01DA041747 · NIDA · SIMON FRASER UNIVERSITY · PI NOSYK, BOHDAN · 2016 to 2025
$5.5M
NIDA NIH HHS R01 DA041747
6 · The paper itself

Abstract

backgroundIn the USA, Black and Hispanic or Latinx individuals continue to be disproportionately affected by HIV. Applying a distributional cost-effectiveness framework, we estimated the cost-effectiveness and epidemiological impact of two combination implementation approaches to identify the approach that best meets the dual objectives of improving population health and reducing racial or ethnic health disparities.

methodsWe adapted a dynamic, compartmental HIV transmission model to characterise HIV micro-epidemics in six US cities: Atlanta, Baltimore, Los Angeles, Miami, New York, and Seattle. We considered combinations of 16 evidence-based interventions to diagnose, treat, and prevent HIV transmission according to previously documented levels of scale-up. We then identified optimal combination strategies for each city, with the distribution of each intervention implemented according to existing service levels (proportional services approach) and the racial or ethnic distribution of new diagnoses (between Black, Hispanic or Latinx, and White or other ethnicity individuals; equity approach). We estimated total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios of strategies implemented from 2020 to 2030 (health-care perspective; 20-year time horizon; 3% annual discount rate). We estimated three measures of health inequality (between-group variance, index of disparity, Theil index), incidence rate ratios, and rate differences for the selected strategies under each approach.

findingsIn all cities, optimal combination strategies under the equity approach generated more QALYs than those with proportional services, ranging from a 3·1% increase (95% credible interval [CrI] 1·4-5·3) in New York to more than double (101·9% [75·4-134·6]) in Atlanta. Compared with proportional services, the equity approach delivered lower costs over 20 years in all cities except Los Angeles; cost reductions ranged from $22·9 million (95% CrI 5·3-55·7 million) in Seattle to $579·8 million (255·4-940·5 million) in Atlanta. The equity approach also reduced incidence disparities and health inequality measures in all cities except Los Angeles.

interpretationEquity-focused HIV combination implementation strategies that reduce disparities for Black and Hispanic or Latinx individuals can significantly improve population health, reduce costs, and drive progress towards Ending the HIV Epidemic goals in the USA.

fundingNational Institute on Drug Abuse.

Indexed as

AdolescentAdultCitiesCost-Benefit AnalysisEpidemicsEthnicityFemaleHealth EquityHealth Status DisparitiesHIV InfectionsHumansIncidenceMaleMiddle AgedQuality-Adjusted Life YearsUnited States

Identifiers

PMID34370977
PMCPMC8423356

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.