title: Targeting an alcohol intervention cost-effectively to persons living with HIV/AIDS in East Africa.
abstract: BACKGROUND
  In the current report, we ask if targeting a cognitive behavioral therapy (CBT)-based intervention aimed at reducing hazardous alcohol consumption to HIV-infected persons in East Africa would have a favorable value at costs that are feasible for scale-up.
  
  
  METHODS
  Using a computer simulation to inform HIV prevention decisions in East Africa, we compared 4 different strategies for targeting a CBT intervention-(i) all HIV-infected persons attending clinic; (ii) only those patients in the pre-antiretroviral therapy (ART) stages of care; (iii) only those patients receiving ART; and (iv) only those patients with detectable viral loads (VLs) regardless of disease stage. We define targeting as screening for hazardous alcohol consumption (e.g., using the Alcohol Use Disorders Identification Test and offering the CBT intervention to those who screen positive). We compared these targeting strategies to a null strategy (no intervention) or a hypothetical scenario where an alcohol intervention was delivered to all adults regardless of HIV status.
  
  
  RESULTS
  An intervention targeted to HIV-infected patients could prevent 18,000 new infections, add 46,000 quality-adjusted life years (QALYs), and yield an incremental cost-effectiveness ratio of $600/QALY compared to the null scenario. Narrowing the prioritized population to only HIV-infected patients in pre-ART phases of care results in 15,000 infections averted, the addition of 21,000 QALYs and would be cost-saving, while prioritizing based on an unsuppressed HIV-1 VL test results in 8,300 new infections averted, adds 6,000 additional QALYs, and would be cost-saving as well.
  
  
  CONCLUSIONS
  Our results suggest that targeting a cognitive-based treatment aimed at reducing hazardous alcohol consumption to subgroups of HIV-infected patients provides favorable value in comparison with other beneficial strategies for HIV prevention and control in this region. It may even be cost-saving under certain circumstances.
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, New York.
authors.forename: Jason
authors.initials: J
authors.lastname: Kessler
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, New York.
authors.forename: Kelly
authors.initials: K
authors.lastname: Ruggles
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, New York.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Anik
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, New York.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Nucifora
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, New York.
authors.forename: Lifeng
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
authors.affiliation: National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.
authors.forename: Kendall
authors.initials: K
authors.lastname: Bryant
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, New York.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D000428:Alcohol Drinking / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000379:methods*; D061345:Early Medical Intervention / Q000191:economics / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic / Q000191:economics / Q000379:methods
keywords: Alcohol; Cost-Effectiveness; HIV Prevention; Mathematical Modeling