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Modeling the impact of focused strategies on the cost and effectiveness of TLC-Plus (or "Test and Treat") in New York City . Kessler, J. Myers, J.E. ; Nucifora, K.A. ; Mensah, N. ; Kowalski, A. ; Sweeney, M. ; Toohey, C. ; Shepard, C. ; Cutler, B. ; Braithwaite, R.S. - PowerPoint PPT Presentation
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Kessler, J. Myers, J.E. ; Nucifora, K.A. ; Mensah, N. ; Kowalski, A. ; Sweeney, M. ; Toohey, C. ; Shepard, C. ; Cutler, B. ; Braithwaite, R.S.
Modeling the impact of focused strategies on the cost and effectiveness of TLC-Plus
(or "Test and Treat") in New York City
Presented by Jason Kessler , M.D., M.P.HNo disclosures or conflicts of interest to report
July 23, 2012IAS 2012
• Backgroundo HPTN 052 strengthened evidence base for HIV treatment as a
prevention strategyo TLC-Plus: community level “test and treat” intervention being tested in
HPTN 065 (Bronx, NY and Washington DC)
• Objectiveso To evaluate the impact of prioritization of TLC-Plus strategies in New
York City (NYC).o To identify optimal prioritization strategies for given budget scenarios
(i.e. “biggest bang for the buck”)
Background and Objectives
• Integrated compartmental model (transmission) with microsimulation model (disease progression)
• Background Inputs: o HIV testing probability (per year) = 31%o Linkage to care probability (within 90 days) = 75%o Adherence probability= 63%
• Intervention effects: o Increases HIV testing probability by 33%, linkage to care by 30% and adherence by 20% in prioritized populationo Secondary effects of increased condom usage, and more monogamous relationships
• Prioritization strategies compared:o General population (1)o All MSM (3)o All IDU (4)o High risk sexual networks (HR)
• all (2)• among MSM (5)• among IDU (6)• among MSM/IDU (7)
Methods
1
23
4567
High risk sexual networks (HR)
IDU
MSM
Impact of different prioritization strategies of TLC-Plus over 20 years in NYC
% o
f HIV
infe
ctio
ns
aver
ted
New
HIV
infe
ctio
ns
% of HIV infections averted
Number of new HIV infections
0%5%
10%15%20%25%30%
0tan28a5660280tan16a5687160tan6a571560tan25a5742250tan14a5769140tan2a579720tan22a5824220tan11a585111
1.000 10000000001.000 20000000001.0000%
5%
10%
15%
20%
25%
30%General population
All high risk sexual networks
High risk sexual networks among IDUs
High risk sexual networks among IDU/MSM
Total cost over 20 years - US$
% H
IV in
fect
ions
ave
rted
Efficient frontier of prioritization strategies of TLC-Plus
All MSM
High risk sexual networks among MSM
All IDU
• TLC-Plus can prevent thousands of new HIV infections in NYC
• With conservative assumptions we find more modest impact of TLC-
Plus than other models of “test and treat” strategies
• Focusing implementation of TLC-Plus among certain subpopulations
(or neighborhoods where key subpopulations may concentrate) can
render this intervention more cost-effective o Increase in feasibility.
Conclusions