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Prior research suggests that the interconnections between substance use, HIV risk and lack of adherence to HIV medications are especially strong among homeless individuals. Thus, study of these interconnections warrants public health attention. The objectives of this paper are to describe patterns of alcohol and drug use, associations between substance use and participation in high-risk sex, and associations between substance use and adherence to HIV treatment regimens among a sample of 602 homeless or unstably housed HIV-seropositive individuals who are part of a housing-based intervention - the Housing and Health Study. Participants experienced high levels of substance use. Significant associations were found between substance use and adherence to HIV treatment medications, and between substance use and high-risk sexual practices within the entire group. Group analyses by sexual orientation/gender show that the association between substance use and treatment adherence is found primarily among heterosexual males whereas the relationship between several drugs and high-risk sexual practices is strongest among gay and bisexual men. Health professionals working with HIV-seropositive individuals should routinely ascertain housing status and screen for substance use and risky sex. [ABSTRACT FROM AUTHOR]

INTRODUCTION: When adjusted for inflation, the federal investment in human immunodeficiency virus (HIV) prevention in the United States has been trending downward for several years. However, for fiscal year 2007, President Bush has proposed to Congress a $93 million increase in HIV prevention efforts focused on HIV counseling and rapid testing in high-risk communities. OBJECTIVE: Here, we estimate the coverage level of an investment of $93 million for rapid testing and counseling services, estimate the number of HIV infections that might be expected to be prevented by this initiative, and calculate the cost-per-infection-prevented. METHODS: Standard methods of scenario and cost-effectiveness analysis were employed, and a 1-year time horizon was used. Calculations were done assuming both a societal perspective and a payor perspective. RESULTS: Assuming full societal perspective costs, about 1.4 million clients could be reached, but if the payor's perspective is used (and clients are assumed to absorb the costs of their time spent and transportation), then coverage could expand to 2.9 million clients. Depending on the perspective used, it is estimated that between 13,014 and 26,984 persons living with HIV could newly learn their serostatus, and that between 1,223 and 2,537 HIV infections could be prevented as a function of the initiative. Under both societal and payor perspectives, the gross cost per infection averted is less than the medical care costs for one case of HIV disease. CONCLUSIONS: We conclude that the president's proposed $93 million initiative for HIV counseling and rapid testing in the United States would have favorable public health benefits and be cost saving to society (even if it does not address all unmet HIV prevention needs in the United States). However, future research should seek to determine whether rapid counseling and testing are the optimal use of a new $93 million investment in HIV prevention. [ABSTRACT FROM AUTHOR]

Federal public health programs use a mix of formula-based and competitive methods to allocate funds among states and other constituent jurisdictions. Characteristics of formula-based allocations used by a convenience sample of four programs, three from the Centers for Disease Control and Prevention and one from the Health Resources and Services Administration, are described to illustrate formula-based allocation methods in public health. Data sources in these public health formulas include population counts and funding proportions based on historical precedent. None include factors that adjust allocations based on variations in the availability of local resources or the cost of delivering services. Formula-funded activities are supplemented by programs that target specific prevention needs or encourage development of innovative methods to address emerging problems, using set-aside funds. A public health finance research agenda should address ways to improve the fit between funding allocation formulas and program objectives. [ABSTRACT FROM AUTHOR]

The decline in AIDS deaths in the USA between 1995 and 2002 has been attributed by Centers for Disease Control (CDC) to HIV treatments advances. The purpose of the present study is to assess whether this AIDS deaths decline was due entirely to treatment advances, to earlier prevention successes, or a combination of both. Secondarily, we quantitatively estimate the number of AIDS deaths averted (or delayed) by treatment advances over and above prevention effects. The study employed scenario analysis to address the research questions. To answer the primary research question, we examined whether three key predictions derived from the shape and peak of the HIV incidence curve in the USA (and the natural history of HIV disease in the era before highly active antiretroviral therapy [HAART]) about the shape and peak of the AIDS deaths curve were upheld (e.g., one prediction was that the peak of the AIDS deaths curve should occur 10-12 years after the peak of the HIV incidence curve). To the extent that these predictions are supported, there is evidence that earlier HIV prevention efforts impacted the number of AIDS deaths later in the epidemic. To answer the second research question, the observed annual AIDS deaths curve (1995-2002) was compared with three estimated AIDS deaths curves that may have occurred had HAART never became available. Three estimations were employed to reflect a range of assumptions about the lag between the flattening of HIV incidence in the USA and the flattening of AIDS deaths (i.e., 10, 11 or 12 years). For any one of the three-scenario analyses, the quantitative area between the 'observed' and 'estimated' AIDS deaths curves provide an estimate of the number of AIDS deaths averted by HIV/AIDS treatments. The three predictions from the HIV incidence curve (and the pre-HAART natural history of HIV disease) for determining the shape and peak of the AIDS deaths curve were supported thereby indicating the influence of past prevention efforts on recent AIDS deaths. However, the observed decline in AIDS deaths was more precipitous than predicted (indicating the influence of treatment advances). The scenario analyses indicated that between 33,480 and 41,784 AIDS deaths were averted (or delayed) between 1995 and 2002 as a function of treatment. That is, approximately, 206,037 AIDS deaths occurred between 1995 and 2002 (in the HAART era), but between 239,517 and 247,821 likely would have occurred without the advent of HAART. We conclude that both past prevention and current treatment services have lead to the AIDS deaths decline in the USA, and that HAART has averted between 33,480 and 41,784 AIDS deaths in the USA between 1995 and 2002 over and above the effects of early prevention efforts. [ABSTRACT FROM AUTHOR]

Economic evaluations of researched HIV-prevention interventions assist service providers in decision making and can help disseminate effective interventions into practice. The study described in this article presents a cost analysis of an intervention that was effective in a research setting. This article also provides threshold analyses that set performance standards to determine if an intervention is cost-effective or cost-saving. From a service provider's perspective, the cost for this intervention is estimated at 50306.40 US dollars for one year (for 150 clients). The base-case, cost per client of this intervention is estimated at 335.38 US dollars. Threshold analyses revealed that in order for Safety Point to be considered cost-saving, it should avert at least 0.411 HIV infections per 150 clients. [ABSTRACT FROM AUTHOR]

This exploratory study assessed the state-level association between social capital, poverty, and income inequality and adolescents' sexual risk and protective behaviors. A cross-sectional design using state-level correlations was employed. Seven outcome measures from the national 1999 Youth Risk Behavior Surveillance Survey were used. For females and males, social capital was significantly associated with five of the seven outcome measures (all associations p < 01). For females, the amount of variance explained by these correlations ranged from 23% to 45%; the range for males was 20% to 52%. Poverty was not a significant predictor of any outcome variable. Income inequality was a significant predictor of birth control usage among females, but in multivariate regression analyses, only social capital retained significance. Findings provide preliminary evidence that social capital may have a profound influence of adolescents' sexual risk and protective behaviors. Social capital was inversely correlated with sexual risk behaviors and positively correlated with protective sexual behaviors. Further and more comprehensive research involving social capital and adolescents is warranted. [ABSTRACT FROM AUTHOR]

This article presents a brief, logical framework that can be used in conducting a review of the comprehensiveness of any governmental human immunodeficiency virus (HIV) prevention program at the local, state, or national level. The framework, presented as a checklist of questions, could be used by external evaluators of an HIV prevention program, used internally for continuous quality improvement, or a combination of the two. The checklist can be used to select components of HIV prevention programs in need of particular, critical improvements. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the cost-effectiveness of a state-of-the-art sexual-risk reduction intervention for high-risk men and women. The main intervention consisted of seven small-group sessions based on well-established principles of cognitive-behavioral therapy. This intervention was compared with a single-session video-based risk reduction intervention. The main outcome measure was the incremental cost-utility ratio, which equals the additional cost per additional quality-adjusted life year (QALY) saved by the cognitive-behavioral intervention, in comparison with the video intervention. A mathematical model of HIV transmission was used to translate reported sexual behavior changes into estimates of the number of HIV infections averted by the interventions, and associated savings in QALYs and averted HIV-related medical costs. For women, the incremental cost-utility ratio equaled $32,688 per QALY saved, which indicates that the cognitive-behavioral intervention was cost-effective compared to the video intervention. For men, the incremental cost-utility ratio was slightly negative, suggesting that the cognitive-behavioral intervention was highly cost-effective, or even cost-saving, compared to the video intervention. This analysis indicates that both brief and intensive sexual risk reduction interventions for high-risk populations can be cost-effective. [ABSTRACT FROM AUTHOR]

In this paper we review the cost-effectiveness of HIV counseling and testing in various settings and populations in preventing the sexual transmission of human immunodeficiency virus, and we discuss how multiple and changing goals have influenced economic evaluations of these programs. The literature indicates that these interventions are generally cost-effective if targeted to groups of infected or high-risk individuals, although there is continuing debate over the efficacy of HIV counseling and testing in changing sexual behavior. For these reasons, HIV counseling and testing programs should be part of an overall prevention strategy which also includes more intensive sexual risk-reduction interventions such as individual, small-group, and community-level approaches. [ABSTRACT FROM AUTHOR]

Because resources to fund HIV prevention are limited, public health decision makers-such as health departments and HIV prevention community planning groups-need to know which prevention strategies are the most cost-effective. In the past several years, a number of studies have appeared in the literature that assess the cost-effectiveness of interventions to prevent the sexual transmission of HIV in the United States. Here, we comprehensively review 16 such studies and then outline an agenda for further research to advance the cost-effectiveness literature and to make the findings of these studies more useful for public health decision makers. The research summarized here provides compelling evidence that interventions to prevent sexual transmission of HIV can be highly cost-effective. Small-group, community-level, and outreach-based sexual risk reduction interventions, in particular, appear to be very efficient strategies for preventing the spread of HIV in moderate- to high-risk populations. [ABSTRACT FROM AUTHOR]

In the United States, HIV prevention programs have historically tailored activities for specific groups primarily on the basis of behavioral risk factors and demographic characteristics. Through the Serostatus Approach to Fighting the Epidemic (SAFE), the Centers for Disease Control and Prevention is now expanding prevention programs, especially for individuals with HIV, to reduce the risk of transmission as a supplement to current programs that primarily focus on reducing the risk of acquisition of the virus. For individuals with HIV, SAFE comprises action steps that focus on diagnosing all HIV-infected persons, linking them to appropriate high-quality care and prevention services, helping them adhere to treatment regimens, and supporting them in adopting and sustaining HIV risk reduction behavior. SAFE couple a traditional infectious disease control focus on the infected person with behavioral interventions that have been standard for HIV prevention programs. [ABSTRACT FROM AUTHOR]

Since 1994, the Centers for Disease Control and Prevention has required that the 65 health department grantees that receive funding for HIV prevention interventions engage in a community planning process to involve affected communities in local prevention decision making; to increase the use of epidemiological data to target HIV prevention resources; and to ensure that the planning process takes into account scientific information on the effectiveness and efficiency of different HIV interventions. Local community planning groups are charged with identifying and prioritizing unmet HIV prevention needs in their communities, as well as prioritizing prevention interventions designed to address these needs. Their recommendations, in turn, form the basis for the local health department's request for HIV prevention funding from the Centers for Disease Control and Prevention. Given the community planning process's central role in the allocation of federal HIV prevention funds, it is critical that sound decision-making procedures inform this process. In this article, we review the basics of the community planning prioritization process and summarize the decision-making experiences of community planning groups across the US. We then describe several priority-setting tools and decision analytic models that have been developed to assist in HIV community planning prioritization and discuss their strengths and weaknesses. Finally, we offer suggestions for improving the decision-analytic basis for HIV prevention community planning. [ABSTRACT FROM AUTHOR]

Community-based AIDS service organizations (ASOs) are important providers of HIV prevention services in cities throughout the United States. This study examined the types of HIV prevention programs that are being undertaken by ASOs and assessed the kinds of new programs that ASOs feel are needed as the HIV epidemic continues to evolve. Factors that will need attention as new HIV prevention programs are developed by ASOs include high turnover of personnel in the organizations, capacity building that will be needed for ASOs to offer more intensive or specialized programs, and strategies to provide technical assistance as ASOs develop new types of programs. [ABSTRACT FROM AUTHOR]

In this study, we propose a framework for assessing the economic value of condoms and provide estimates of the potential societal savings, in the form of decreased HIV-related medical care and lost productivity costs, that accrue from use of condoms. A probabilistic model of HIV transmission was used to estimate reductions in HIV risk attributable to condom use. This estimate was combined with an estimate of the cost to society of a single case of HIV infection to determine a lower bound for the potential societal savings associated with condom use. Several condom use scenarios were considered (including multiple uses with a single partner and multiple uses with multiple partners) for each of three populations: low-risk heterosexuals, high-risk heterosexuals, and men who have sex with men. The savings exceeded the estimated cost of producing and distributing condoms in all but one of the scenarios considered. For multiple condom uses, the per-condom savings ranged from about 500 for low-risk heterosexuals to over $500 for multi-partnered men who have sex with men. [ABSTRACT FROM AUTHOR]

The proportion of times that participants used condoms during the recall period is the measure most often used to assess the impact of an intervention designed to prevent the transmission of HIV through sexual contact. Here, it is argued that researchers, service providers, and policy makers should consider using a regression-based approach to control for differences in sexual activity and assess the impact of their programs. Unlike the proportion, a regression-based summary measure is defined when individuals report that they did not have sex during the recall period, and varies among individuals who report different levels of sexual activity. More importantly, a regression-based approach lends itself to studying relationships between the determinants of condom use and the determinants of sexual activity. [ABSTRACT FROM AUTHOR]

OBJECTIVES: A human immunodeficiency virus (HIV) intervention trial for women at high risk for acquired immunodeficiency syndrome and attending an urban clinic was reported previously. The behavioral group intervention was shown to increase condom use behaviors significantly. This study retrospectively assessed the intervention's cost-effectiveness. METHODS: Standard methods of cost and cost-utility analysis were used. RESULTS: The intervention cost was just over $2000 for each quality-adjusted life-year saved; this is favorable compared with other life-saving programs. However, the results are sensitive to changes in some model assumptions. CONCLUSIONS: Under most scenarios, the HIV prevention intervention was cost-effective. [ABSTRACT FROM AUTHOR]

Objective: To advocate the use of standard measures of sexual behavior in order to facilitate determining the extent to which an HIV-prevention intervention has changed participants' behavior. Methods: The need for a standardized minimum data set is reviewed and a candidate data set is proposed. Results: The following data constitute the proposed minimum data set: (1) number of sexual intercourse partners; (2) number of acts of unprotected intercourse, per partner; and (3) number of condom-protected intercourse acts, per partner. Conclusion: Standardizing measures used in HIV-prevention research would facilitate cross-study comparison and thereby assist HIV-prevention policy makers and program planners in selecting effective programs. [ABSTRACT FROM AUTHOR]

Because of the enormity of the HIV-AIDS epidemic and the urgency for preventing transmission, HIV prevention programs are a high priority for careful and timely evaluations. Information on program effectiveness and efficiency is needed for decision-making about future HIV prevention priorities. General characteristics of successful HIV prevention programs, programs empirically evaluated and found to change (or not change) high-risk behaviors or in need of further empirical study, and economic evaluations of certain programs are described and summarized with attention limited to programs that have a behavioral basis. HIV prevention programs have an impact on averting or reducing risk behaviors, particularly when they are delivered with sufficient resources, intensity, and cultural competency and are based on a firm foundation of behavioral and social science theory and past research. Economic evaluations have found that some of these behaviorally based programs yield net economic benefits to society, and others are likely cost-effective (even if not cost-saving) relative to other health programs. Still, specific improvements should be made in certain HIV prevention programs. [ABSTRACT FROM AUTHOR]

To maximize the impact of public spending on HIV prevention, program managers, community planning groups, and other decision makers need accurate information on the economic efficiency (i.e., the relative balance between costs and consequences) of alternative HIV prevention strategies. This paper describes a technique for evaluating the economic efficiency of HIV behavioral risk reduction interventions within a cost-utility analytic framework. To determine the cost-effectiveness of the intervention, standardized values of the lifetime cost of treating HIV/AIDS and the number of quality-adjusted life years lost when someone becomes infected with HIV are combined with information about overall program costs and a model-based estimate of the number of infections averted by the intervention. The use of a standardized economic evaluation methodology for HIV prevention research, such as that proposed here, enhances cross-study comparability and thereby facilitates informed resource allocation decision making. [ABSTRACT FROM AUTHOR]

Choosing outcome measures for HIV prevention intervention studies is difficult because of the multiplicity of behavioral and epidemiologic factors that affect HIV transmission. In attempts to address some of these factors, summary risk indices have been proposed as outcome measures for some intervention studies. These summary risk indices have suffered from a number of methodological difficulties (e.g., some indices are not expressed in meaningful units). We present six criteria that can be used to judge the soundness of summary risk indices. Further, we illustrate that the central equation from a (Bemoullian) mathematical model of HIV transmission can be used as a summary risk index, and that it meets these six criteria. [ABSTRACT FROM AUTHOR]

The present study sought to determine the cost per discounted quality-adjusted-life-year (QALY) saved by a small group workshop-format, cognitive-behavioral HIV-prevention intervention for gay men. The methodology employed was a retrospective cost-utility analysis of the behavioral intervention. The ability of the intervention to effect HIV-related behavior change was previously assessed in a randomized controlled trial. In the original trial, clients were recruited from gay bars, health department clinics, and other community settings in metropolitan area of 400,000 residents; the intervention was delivered in a medical school outreach setting. The participants were 104 gay men; 87% of the clients identified their race/ethnicity as White, 13% as ethnic minority. The experimental intervention was comprised of 12 sessions and provided HIV-related risk behavior education, self-management and sexual assertion training, and development of reliable and positive social support networks. The comparison condition was a wait-list control group. The main outcome measure in our retrospective cost-utility analysis was 'cost per discounted QALY saved.' Under base case assumptions, the cost of the intervention was $24,000 (rounded to the nearest thousand). The discounted medical costs averted by preventing HIV infection were $42,000. Approximately 5.5 discounted QALYs were saved. Hence the intervention is cost-saving under base case assumptions (i.e., the cost per discounted QALY saved ratio is less than zero). The results are generally robust to changes in cost-utility analysis model parameters and assumptions. Because the intervention is cost-saving under base case assumptions, it compares favorably to other health service interventions in which society currently invests. Behavioral interventions such as the one examined here should receive serious consideration for investment by public health decision makers allocating fiscal resources for health services. [ABSTRACT FROM AUTHOR]

Objective. To calculate the national costs of reducing perinatal transmission of human immunodeficiency virus through counseling and voluntary testing of pregnant women and zidovudine treatment of infected women and their infants, as recommended by the Public Health Service, and to compare these costs with the savings from reducing the number of pediatric infections. Method. The authors analyzed the estimated costs of the intervention and the estimated cost savings from reducing the number of pediatric infections. The outcome measures are the number of infections prevented by the intervention and the net cost (cost of intervention minus the savings from a reduced number of pediatric HIV infections). The base model assumed that intervention participation and outcomes would resemble those found in the AIDS Clinical Trials Group Protocol 076. Assumptions were varied regarding maternal seroprevalence, participation by HIV-infected women, the proportion of infected women who accepted and completed the treatment, and the efficacy of zidovudine to illustrate the effect of these assumptions on infections prevented and net cost. Results. Without the intervention, a perinatal HIV transmission rate of 25% would result in 1750 HIV-infected infants born annually in the United States, with lifetime medical-care costs estimated at $282 million. The cost of the intervention (counseling, testing, and zidovudine treatment) was estimated to be $67.6 million. In the base model, the intervention would prevent 656 pediatric HIV infections with a medical care cost saving of $105.6 million. The net cost saving of the intervention was $38.1 million. Conclusion. Voluntary HIV screening of pregnant women and ziovudine treatment for infected women and their infants resulted in cost savings under most of the assumptions used in this analysis. These results strongly support implementation of the Public Health Service recommendations for this intervention. [ABSTRACT FROM AUTHOR]

NEW RAPID HUMAN immunodeficiency virus (HIV) antibody tests permit many individuals to receive test results and appropriate counseling at one clinic visit. Because currently used tests require significant time for processing, all individuals must return for a second visit for test results and counseling. Since return rates for the second visit are low, the more rapid tests present an opportunity to improve the efficiency of HIV counseling and testing. The authors compared the costs and effectiveness of the currently used counseling and testing procedure and a streamlined procedure made possible by the new, more rapid screening tests. When test-positive clients are given preliminary screening test results, the rapid procedure is more cost-effective than the current procedure. Since over 90% of the clients in most clinics will test negative, the rapid counseling and testing procedure allows the vast majority of clients to be counseled and tested and to receive their results and posttest counseling in one visit. However, in the case where the goal of HIV counseling and testing is to focus only on infected individuals, if information regarding a positive result from the rapid screening test is not given to clients at the initial visit before a confirmatory test is performed, then the rapid counseling and testing procedure is not more cost-effective than the current procedure. [ABSTRACT FROM AUTHOR]

In January 2001, the Centers for Disease Control and Prevention published a national HIV prevention strategic plan with the overarching goal of reducing new HIV infections in the United States from 40,000 to 20,000 per year by 2005, with a particular emphasis on eliminating the racial/ethnic disparities in new infections. In this article, a framework is proposed for tracking progress toward achievement of the goal. Information available to date suggests there apparently has been little progress in achieving the national goal and sparse expansion of resources needed to achieve the goal. [ABSTRACT FROM AUTHOR]

Objective: Previous nonfatal overdose is a key risk factor for drug overdose death; however, current nonfatal overdose surveillance is limited to people who receive medical attention. We identified states that tracked nonfatal overdoses treated in prehospital and hospital care settings, assessed the effects of different surveillance methods on the magnitude of nonfatal overdose estimates, and estimated states' nonfatal-to-fatal overdose ratio., Methods: Two analysts independently reviewed state websites to characterize states' methods of capturing nonfatal overdose events from December 2022 through February 2023. We collected information on surveillance methods in 5 states that met the inclusion criteria, including data source, measure specification, drug(s) involved, and whether states performed deduplication or published mutually exclusive measure specifications to capture unique events across care settings. We calculated nonfatal-to-fatal overdose ratios to assess the effects of different data sources on estimates of nonfatal overdoses., Results: Illinois, Maine, North Carolina, and West Virginia used syndromic surveillance data and New Jersey used hospital discharge data to track nonfatal overdose-related emergency department visits. Illinois and West Virginia tracked nonfatal overdose-related encounters with emergency medical services. Other states tracked opioid overdoses reversed following naloxone administration by emergency medical services, law enforcement, and community members. Maine, New Jersey, and West Virginia published nonfatal overdose information by using mutually exclusive measure specifications; the number of nonfatal overdoses per fatal overdose in these states ranged from approximately 5:1 to 14:1., Practice Implications: Establishing a standard framework to combine data from existing national surveillance systems in prehospital and hospital care settings can improve nonfatal overdose estimates and enable comparisons between jurisdictions to help decision makers identify areas most in need of essential services., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Research and teaching are considered core-responsibilities for academic researchers. "Practice" activities however are viewed as ancillary, despite university emphasis on their importance. As funders, governments, and academia address the role of research in social impact, the deliberations on researcher activism, advocacy and lobbying have seen a resurgence. This study explores the perceptions of 52 faculty and 24 government decisionmakers on the roles, responsibilities, and restrictions of an academic to proactively engage in efforts that can be interpreted under these three terms. Data was coded through inductive thematic analysis using Atlas.Ti and a framework approach. We found that discordant perceptions about how much activism, advocacy and lobbying faculty should be engaging in, results from how each term is defined, interpreted, supported and reported by the individuals, the School of Public Health (SPH), and government agencies. Influential faculty factors included: seniority, previous experiences, position within the institution, and being embedded in a research center with an advocacy focus. Faculty views on support for advocacy were often divergent. We surmise therefore, that for effective and mutually beneficial collaboration to occur, academic institutions need to align rhetoric with reality with respect to encouraging modes and support for government engagement. Similarly, government agencies need to provide more flexible modes of engagement. This will contribute to alleviating confusion as well as tension leading to more effective engagement and consequently opportunity for evidence-informed decision making in public health globally., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2022 Jessani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Only 63% of people living with HIV in the United States are achieving viral suppression. Structural and social barriers limit adherence to antiretroviral therapy which furthers the HIV epidemic while increasing health care costs. This study calculated the cost and cost-effectiveness of a contingency management intervention with cash incentives. People with HIV and detectable viral loads were randomized to usual care or an incentive group. Individuals could earn up to $3650 per year if they achieved and maintained an undetectable viral load. The average 1-year intervention cost, including incentives, was $4105 per patient. The average health care costs were $27,189 per patient in usual care and $35,853 per patient in the incentive group. We estimated a cost of $28,888 per quality-adjusted life-year (QALY) gained, which is well below accepted cost-per-QALY thresholds. Contingency management with cash incentives is a cost-effective intervention for significantly increasing viral suppression., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)