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Expanded Screening, Treatment Could Reduce New HIV Infections

But reduction in risky behavior required to reduce infection rate substantially

THURSDAY, Dec. 23 (HealthDay News) -- Expanding screening and treatment for HIV would likely reduce the rate of new infections, especially if combined with interventions that result in less risky behavior, according to research published in the Dec. 21 issue of the Annals of Internal Medicine.

Elisa F. Long, Ph.D., of the Yale School of Management in New Haven, Conn., and colleagues used a dynamic mathematical model of HIV transmission and progression and a cost-effectiveness analysis to evaluate the effects of expanded antiretroviral therapy (ART), HIV screening, and risky behavior-reducing interventions on the HIV epidemic in the United States.

By base-case analysis, the researchers determined that one-time screening of low-risk people and annual screening of high-risk people -- if resulting in a 20 percent reduction of sexual activity -- could prevent 6.7 percent of new infections at a cost of $22,382 per quality-adjusted life-year (QALY) gained. Similarly, they calculated that expanding ART use to 75 percent of eligible individuals would prevent 10.3 percent of infections and cost $20,300 per QALY gained. By sensitivity analysis, with no reduction in sexual activity, they determined that expanded screening could prevent 3.7 percent of new infections. Initiation of ART early on may prevent 20 to 28 percent of infections, and additional efforts to cut risky behavior in half could reduce infections by 65 percent.

"Expanding HIV screening and treatment simultaneously offers the greatest health benefit and is cost-effective. However, even substantial expansion of HIV screening and treatment programs is not sufficient to markedly reduce the U.S. HIV epidemic without substantial reductions in risk behavior," the authors write.

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