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