Social Media Interventions to Promote HIV Testing, Linkage, Adherence, and Retention: Systematic Review and Meta-Analysis.

BACKGROUND: Social media is increasingly used to deliver HIV interventions for key populations worldwide. However, little is known about the specific uses and effects of social media on human immunodeficiency virus (HIV) interventions. OBJECTIVE: This systematic review examines the effectiveness of social media interventions to promote HIV testing, linkage, adherence, and retention among key populations. METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and Cochrane guidelines for this review and registered it on the International Prospective Register of Systematic Reviews, PROSPERO. We systematically searched six databases and three conference websites using search terms related to HIV, social media, and key populations. We included studies where (1) the intervention was created or implemented on social media platforms, (2) study population included men who have sex with men (MSM), transgender individuals, people who inject drugs (PWID), and/or sex workers, and (3) outcomes included promoting HIV testing, linkage, adherence, and/or retention. Meta-analyses were conducted by Review Manager, version 5.3. Pooled relative risk (RR) and 95% confidence intervals were calculated by random-effects models. RESULTS: Among 981 manuscripts identified, 26 studies met the inclusion criteria. We found 18 studies from high-income countries, 8 in middle-income countries, and 0 in low-income countries. Eight were randomized controlled trials, and 18 were observational studies. All studies (n=26) included MSM; five studies also included transgender individuals. The focus of 21 studies was HIV testing, four on HIV testing and linkage to care, and one on antiretroviral therapy adherence. Social media interventions were used to do the following: build online interactive communities to encourage HIV testing/adherence (10 studies), provide HIV testing services (9 studies), disseminate HIV information (9 studies), and develop intervention materials (1 study). Of the studies providing HIV self-testing, 16% of participants requested HIV testing kits from social media platforms. Existing social media platforms such as Facebook (n=15) and the gay dating app Grindr (n=10) were used most frequently. Data from four studies show that HIV testing uptake increased after social media interventions (n=1283, RR 1.50, 95% CI 1.28-1.76). In the studies where social media interventions were participatory, HIV testing uptake was higher in the intervention arm than the comparison arm (n=1023, RR 1.64, 95% CI 1.19-2.26). CONCLUSIONS: Social media interventions are effective in promoting HIV testing among MSM in many settings. Social media interventions to improve HIV services beyond HIV testing in low- and middle-income countries and among other key populations need to be considered. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO): CRD42016048073; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42016048073 (Archived by WebCite at http://www. webcitation.org/6usLCJK3v)

Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India

Background & aims Availability of directly-acting antivirals (DAAs) has changed the treatment landscape of hepatitis C virus (HCV) infection. The high price of DAAs has restricted their use in several countries. However, in some countries such as India, generic DAAs are available at much cheaper price. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective. Methods: A previously-validated, mathematical model was adapted to the HCV-infected population in India to compare the outcomes of no treatment versus treatment with DAAs. Model parameters were estimated from published studies. Cost-effectiveness of HCV treatment using available DAAs was calculated, using a payer’s perspective. We estimated quality-adjusted life years (QALYs), disability-adjusted life years (DALYs), total costs, and incremental cost-effectiveness ratio of DAAs versus no treatment. One-way and probabilistic sensitivity analyses were conducted. Results: Compared with no treatment, the use of generic DAAs in Indian HCV patients would increase the life expectancy by 8.02 years, increase QALYs by 3.89, avert 19.07 DALYs, and reduce the lifetime healthcare costs by $1,309 per-person treated. Treatment became cost-effective within 2 years, and cost-saving within 10 years of its initiation overall and within 5 years in persons with cirrhosis. Treating 10,000 HCV-infected persons could prevent 3400–3850 decompensated cirrhosis, 1800–2500 HCC, and 4000–4550 liver-related deaths. The results were sensitive to the costs of DAAs, pre- and post-treatment diagnostic tests and management of cirrhosis, and quality of life after sustained virologic response. Conclusions: Treatment with generic DAAs available in India will improve patient outcomes, provide a good value for money within 2 years, and be ultimately cost-saving. Therefore, in this and similar settings, HCV treatment should be a priority from a public health as well an economic perspective

Disability-adjusted life years (DALYs) averted with DAA-based treatment in HCV-infected patients in India, in relation to presence or absence of cirrhosis and viral genotype.

<p>Disability-adjusted life years (DALYs) averted with DAA-based treatment in HCV-infected patients in India, in relation to presence or absence of cirrhosis and viral genotype.</p

Cost-effectiveness of directly-acting antiviral drug-based treatment of persons with hepatitis C virus infection at various stages of liver fibrosis in India, depending on modelling time horizon.

<p>Cost-effectiveness of directly-acting antiviral drug-based treatment of persons with hepatitis C virus infection at various stages of liver fibrosis in India, depending on modelling time horizon.</p

Change in adverse clinical outcomes in patients with hepatitis C virus infection in India following treatment using regimens based on directly-acting antiviral drugs available there at low cost.

<p>Abbreviations: DAA, direct-acting antivirals; DC, decompensated cirrhosis; HCC, hepatocellular carcinoma; LRD, liver-related deaths.</p

Cost-effectiveness results comparing model outcomes of no treatment versus treatment with direct-acting antivirals in India.

<p>Cost-effectiveness results comparing model outcomes of no treatment versus treatment with direct-acting antivirals in India.</p

Cost-effectiveness of direct-acting antiviral drug-based treatment of persons with hepatitis C virus infection, by age of starting treatment (years) and time horizon.

<p>DAAs became cost-effective within 2 years of initiation of treatment irrespective of patient’s age; and DAAs became cost-saving for patients of age ≤50 around 10 years but never for patients at the age ≥60.</p

Tornado diagram for one-way sensitivity analysis of incremental cost-effectiveness ratio using (A) peradditionalquality−adjustedlife−year,and(B) per additional quality-adjusted life-year, and (B) per disability-adjusted life-year averted.

<p>Horizontal bars show the variation in incremental cost-effectiveness ratio (ICER; in $/QALY gained or$/DALY averted) with variation in the value of the parameter. In the parameter names, the prefix ‘c’ represents cost of a health-state, ‘q’ the quality-of-life weight and ‘p’ the transition probability from one state to the other. Values of ICER below 0 indicate that the treatment is cost-saving. Abbreviations: QALY = quality-adjusted life-year, DALY = disability-adjusted life-year.</p