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Why Maximizing Quality-Adjusted Life Years, rather than Reducing HIV Incidence, Must Remain Our Objective in Addressing the HIV/AIDS Epidemic.

TitleWhy Maximizing Quality-Adjusted Life Years, rather than Reducing HIV Incidence, Must Remain Our Objective in Addressing the HIV/AIDS Epidemic.
Publication TypeJournal Article
Year of Publication2019
AuthorsNosyk B, Min JEun, Zang X, Feaster DJ, Metsch L, Marshall BDL, Del Rio C, Granich R, Schackman BR, Montaner JSG
JournalJ Int Assoc Provid AIDS Care
Volume18
Pagination2325958218821962
Date Published2019 Jan-Dec
ISSN2325-9582
Abstract

With efficacious behavioral, biomedical, and structural interventions available, combination implementation strategies are being implemented to combat HIV/AIDS across settings internationally. However, priority statements from national and international bodies make it unclear whether the objective should be the reduction in HIV incidence or the maximization of health, most commonly measured with quality-adjusted life years (QALYs). Building off a model-based evaluation of HIV care interventions in British Columbia, Canada, we compare the optimal sets of interventions that would be identified using HIV infections averted, and QALYs as the primary outcome in a cost-effectiveness analysis. We found an explicit focus on averting new infections undervalues the health benefits derived from antiretroviral therapy, resulting in suboptimal and potentially harmful funding recommendations.

DOI10.1177/2325958218821962
Alternate JournalJ Int Assoc Provid AIDS Care
PubMed ID30798657
PubMed Central IDPMC6457342
Grant ListR01 DA041747 / DA / NIDA NIH HHS / United States
Division: 
Comparative Effectiveness & Outcomes Research
Category: 
Faculty Publication