Multivariate analysis with best fit models for HIV/HCV coinfection using both forwards and backwards regression modeling with AIC and Pearson's correlation for bivariate correlations with p<.05.

<p>Hepatitis C and HIV monoinfected groups are included for comparison.</p><p>HIV  =  Human Immunodeficiency Virus; HCV  =  Hepatitis C Virus; MSM  =  Men-Who-Have-Sex-with-Men; WSW  =  Women-Who-Have-Sex-with-Women; STI  =  Sexually Transmitted Infection; AIC  =  Akaike Information Criteria; BIC =  Bayesian Information Criterion.</p

Characteristics among patients with completed surveys with HIV/HCV coinfection as compared to patients with HIV monoinfection, HCV monoinfection, and those neither infected with HIV nor HCV.

<p>(N = 7473).</p>a<p>P-value reported using the Kruskal-Wallis test; ^b P-value not significant using Dunn's multiple corrections test.</p>*<p>p<0.05 comparing the non-infected group with each of the other groups using Dunn's multiple corrections test.</p><p>Legend: HIV  =  Human Immunodeficiency Virus; HCV  =  Hepatitis C Virus; MSM  =  Men-Who-Have-Sex-with-Men; WSW  =  Women-Who-Have-Sex-with-Women; STI  =  Sexually Transmitted Infection; PWID  =  Person Who Injects Drugs; “Speedball”  =  Injected Mixture of Cocaine and Heroin.</p

Bivariate logistic regression comparisons of HIV/HCV coinfection, HCV monoinfection, and HIV monoinfection compared to patients without infection.

<p>HIV  =  Human Immunodeficiency Virus; HCV  =  Hepatitis C Virus; MSM  =  Men-Who-Have-Sex-with-Men; WSW  =  Women-Who-Have-Sex-with-Women; STI  =  Sexually Transmitted Infection; PWID  =  Person Who Injects Drugs; “Speedball”  =  Injected Mixture of Cocaine and Heroin.</p

Geospatial density of HIV/HCV Coinfection, HCV Monoinfection, and HIV Monoinfection, respectively, in CHCV population by Census Block Group, 2003-2011.

<p>(N = 7,720).</p

Graphical Representation of Overlapping Relationships Between HIV/HCV Coinfection, HCV Monoinfection and HIV Monoinfection, 2003-2011.

<p>(N = 7473) MSM  =  Men-Who-Have-Sex-with-Men; STI  =  Sexually Transmitted Infection.</p

One-way sensitivity analysis for generic efavirenz price reduction.

<p>EFV, efavirenz; ICER, incremental cost-effectiveness ration; QALY, quality adjusted life years.</p

Cost-Effectiveness Analysis of Brief and Expanded Evidence-Based Risk Reduction Interventions for HIV-Infected People Who Inject Drugs in the United States

<div><p>Aims</p><p>Two behavioral HIV prevention interventions for people who inject drugs (PWID) infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+), a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+) Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST), to the status quo in the U.S.</p><p>Methods</p><p>A dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs) gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy.</p><p>Results</p><p>Over 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY), and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone.</p><p>Conclusions</p><p>Both behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+.</p></div

Cost-Effectiveness of Intervention Strategies.

<p>HHRP+: Holistic Health Recovery Program for HIV+; OST: opioid substitution therapy; QALY: quality-adjusted life year; 3H+: Holistic Health for HIV.</p

Estimated HIV Prevalence among PWID and Non-PWID.

<p>HHRP+: Holistic Health Recovery Program for HIV+; HIV: human immunodeficiency virus; OST: opioid substitution therapy; PWID: people who inject drugs; 3H+: Holistic Health for HIV.</p

Relative Effectiveness vs. Cost of 3H+ vs. HHRP+.

<p>HHRP+: Holistic Health Recovery Program for HIV+; 3H+: Holistic Health for HIV.</p