The epidemiological impact and cost-effectiveness of HIV testing, antiretroviral treatment and harm reduction programs.
OBJECTIVE
To estimate trends in the HIV epidemic in China, and explore the epidemiological impact and cost-effectiveness of expanded voluntary counseling and testing (VCT), antiretroviral treatment (ART), and harm reduction programs in preventing the spread of HIV.


METHODS
A mathematical model was developed and calibrated to reflect the dynamics of disease progression and transmission through sexual contacts and needle sharing in China, and the cost-effectiveness of four interventions was analyzed. Multivariate sensitivity analysis was used to estimate uncertainty ranges for all outcomes.


RESULTS
A total of 3.4 million new HIV infections were estimated to occur over the next 30 years if no preventive measures were implemented, of which 75% will occur in high-risk groups, such as injecting drug users (IDUs) and men who have sex with men. Expanding ART treatment is most cost-effective, at 4840 (uncertainty range/UR: 3960-5980) international dollars per quality-adjusted life year gained. The optimal cost-effectiveness path is from ART to the combination strategy of ART and harm reduction, followed by the combination strategy of harm reduction, ART and VCT.


CONCLUSIONS
Expanded VCT (low-risk once, high-risk annually), expanded ART, harm reduction programs and all combinations of these strategies are cost-effective relative to the base case. In order to bring China to a lower phase of the HIV epidemic, in addition to VCT and ART treatment, efforts in reducing risk behavior will be necessary.
Department of Global Health Policy, The University of Tokyo, Tokyo, Japan. lijinghua@cuhk.edu.hk
Jinghua
J
Li
Stuart
S
Gilmour
Haiqiang
H
Zhang
Ai
A
Koyanagi
Kenji
K
Shibuya
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000191:economics; D002681:China / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D040261:Harm Reduction; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000453:epidemiology*
D019380:Anti-HIV Agents