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The Potential Epidemiological Impact of Coronavirus Disease 2019 (COVID-19) on the Human Immunodeficiency Virus (HIV) Epidemic and the Cost-effectiveness of Linked, Opt-out HIV Testing: A Modeling Study in 6 US Cities

Authors :
Zang, Xiao
Krebs, Emanuel
Chen, Siyuan
Piske, Micah
Armstrong, Wendy S
Behrends, Czarina N
Del Rio, Carlos
Feaster, Daniel J
Marshall, Brandon D L
Mehta, Shruti H
Mermin, Jonathan
Metsch, Lisa R
Schackman, Bruce R
Strathdee, Steffanie A
Nosyk, Bohdan
Dombrowski, Julia C
Gebo, Kelly A
Kirk, Gregory
Montaner, Julio
Pandya, Ankur
Shoptaw, Steven
Source :
Clinical Infectious Diseases
Publication Year :
2020
Publisher :
Oxford University Press (OUP), 2020.

Abstract

Background Widespread viral and serological testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present a unique opportunity to also test for human immunodeficiency virus (HIV) infection. We estimated the potential impact of adding linked, opt-out HIV testing alongside SARS-CoV-2 testing on the HIV incidence and the cost-effectiveness of this strategy in 6 US cities. Methods Using a previously calibrated dynamic HIV transmission model, we constructed 3 sets of scenarios for each city: (1) sustained current levels of HIV-related treatment and prevention services (status quo); (2) temporary disruptions in health services and changes in sexual and injection risk behaviors at discrete levels between 0%–50%; and (3) linked HIV and SARS-CoV-2 testing offered to 10%–90% of the adult population in addition to Scenario 2. We estimated the cumulative number of HIV infections between 2020–2025 and the incremental cost-effectiveness ratios of linked HIV testing over 20 years. Results In the absence of linked, opt-out HIV testing, we estimated a total of a 16.5% decrease in HIV infections between 2020–2025 in the best-case scenario (50% reduction in risk behaviors and no service disruptions), and a 9.0% increase in the worst-case scenario (no behavioral change and 50% reduction in service access). We estimated that HIV testing (offered at 10%–90% levels) could avert a total of 576–7225 (1.6%–17.2%) new infections. The intervention would require an initial investment of $20.6M–$220.7M across cities; however, the intervention would ultimately result in savings in health-care costs in each city. Conclusions A campaign in which HIV testing is linked with SARS-CoV-2 testing could substantially reduce the HIV incidence and reduce direct and indirect health care costs attributable to HIV.

Details

Language :
English
ISSN :
15376591 and 10584838
Database :
OpenAIRE
Journal :
Clinical Infectious Diseases
Accession number :
edsair.doi.dedup.....57f3c874733a39b3748143aa91196f2b
Full Text :
https://doi.org/10.1093/cid/ciaa1547