Pooyan Kazemian1, Delaney D Ding2, Justine A Scott2, Mary K Feser2, Katie Biello3,4,5,6, Beena E Thomas7, Alpana Dange8, C Andres Bedoya9,10, Vinoth Balu7, Shruta Rawat8, Nagalingeswaran Kumarasamy11, Matthew J Mimiaga6,12,13,14, Conall O'Cleirigh6,9,10, Milton C Weinstein15,16, Jacob Prem Kumar7, Senthil Kumar8, Kenneth H Mayer6,10,17,18, Steven A Safren19,20,21, Kenneth A Freedberg2,10,15,18,22,23. 1. Department of Operations, Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio. 2. Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts. 3. Center for Health Promotion and Health Equity. 4. Department of Behavioral and Social Sciences. 5. Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island. 6. The Fenway Institute, Fenway Health, Boston, Massachusetts, USA. 7. National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu. 8. The Humsafar Trust, Mumbai, Maharashtra, India. 9. Behavioral Medicine Program, Massachusetts General Hospital. 10. Harvard Medical School, Boston, Massachusetts, USA. 11. CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services, Chennai, Tamil Nadu, India. 12. Department of Epidemiology, UCLA Fielding School of Public Health. 13. Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine. 14. UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, California. 15. Department of Health Policy and Management. 16. Department of Biostatistics. 17. Department of Global Health and Population, Harvard T.H. Chan School of Public Health. 18. Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts. 19. Center for HIV and Research in Mental Health. 20. Health Promotion and Care Research Program. 21. Department of Psychology, University of Miami, Miami, Florida. 22. Division of General Internal Medicine. 23. Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.
Abstract
OBJECTIVE: MSM in India are at a high risk for HIV infection given psychosocial challenges, sexual orientation stress, and stigma. We examined the cost-effectiveness of a novel resilience-based psychosocial intervention for MSM in India. DESIGN: We parameterized a validated microsimulation model (CEPAC) with India-specific data and results from a randomized trial and examined two strategies for MSM: status quo HIV care ( SQ ), and a trial-based psychosocial intervention ( INT ) focused on building resilience to stress, improving mental health, and reducing condomless anal sex (CAS). METHODS: We projected lifetime clinical and economic outcomes for MSM without HIV initially. Intervention effectiveness, defined as reduction in self-reported CAS, was estimated at 38%; cost was $49.37/participant. We used a willingness-to-pay threshold of US$2100 (2019 Indian per capita GDP) per year of life saved (YLS) to define cost-effectiveness. We also assessed the 5-year budget impact of offering this intervention to 20% of Indian MSM. RESULTS: Model projections showed the intervention would avert 2940 HIV infections among MSM over 10 years. Over a lifetime horizon, the intervention was cost-effective (ICER = $900/YLS). Results were most sensitive to intervention effectiveness and cost; the intervention remained cost-effective under plausible ranges of these parameters. Offering this intervention in the public sector would require an additional US$28 M over 5 years compared with SQ . CONCLUSION: A resilience-based psychosocial intervention integrated with HIV risk reduction counseling among MSM in India would reduce HIV infections and be cost-effective. Programs using this approach should be expanded as a part of comprehensive HIV prevention in India.
OBJECTIVE: MSM in India are at a high risk for HIV infection given psychosocial challenges, sexual orientation stress, and stigma. We examined the cost-effectiveness of a novel resilience-based psychosocial intervention for MSM in India. DESIGN: We parameterized a validated microsimulation model (CEPAC) with India-specific data and results from a randomized trial and examined two strategies for MSM: status quo HIV care ( SQ ), and a trial-based psychosocial intervention ( INT ) focused on building resilience to stress, improving mental health, and reducing condomless anal sex (CAS). METHODS: We projected lifetime clinical and economic outcomes for MSM without HIV initially. Intervention effectiveness, defined as reduction in self-reported CAS, was estimated at 38%; cost was $49.37/participant. We used a willingness-to-pay threshold of US$2100 (2019 Indian per capita GDP) per year of life saved (YLS) to define cost-effectiveness. We also assessed the 5-year budget impact of offering this intervention to 20% of Indian MSM. RESULTS: Model projections showed the intervention would avert 2940 HIV infections among MSM over 10 years. Over a lifetime horizon, the intervention was cost-effective (ICER = $900/YLS). Results were most sensitive to intervention effectiveness and cost; the intervention remained cost-effective under plausible ranges of these parameters. Offering this intervention in the public sector would require an additional US$28 M over 5 years compared with SQ . CONCLUSION: A resilience-based psychosocial intervention integrated with HIV risk reduction counseling among MSM in India would reduce HIV infections and be cost-effective. Programs using this approach should be expanded as a part of comprehensive HIV prevention in India.
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Authors: Matthew J Mimiaga; Katie Brooks Biello; Murugesan Sivasubramanian; Kenneth H Mayer; Vivek Raj Anand; Steven A Safren Journal: AIDS Care Date: 2013-01-23
Authors: Beena Thomas; Matthew J Mimiaga; Kenneth H Mayer; Elizabeth F Closson; Carey V Johnson; Sunil Menon; Jamuna Mani; R Vijaylakshmi; Meenalochini Dilip; Theresa Betancourt; Steven A Safren Journal: AIDS Educ Prev Date: 2012-12
Authors: Kartik K Venkatesh; Jessica E Becker; Nagalingeswaran Kumarasamy; Yoriko M Nakamura; Kenneth H Mayer; Elena Losina; Soumya Swaminathan; Timothy P Flanigan; Rochelle P Walensky; Kenneth A Freedberg Journal: PLoS One Date: 2013-05-31 Impact factor: 3.240