The epidemiological impact and cost-effectiveness of HIV testing, antiretroviral treatment and harm reduction programs.

OBJECTIVES: 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. DESIGN AND 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.
CONCLUSION: 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.