TUPDD0204
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Title
Estimating plausible ranges on the scale of implementation for evidence-based HIV/AIDS interventions in the US
Presenter
Emanuel Krebs
Authors
E. Krebs1, B. Enns1, X. Zang1, C. Del Rio2, J. Dombrowski3, C. Behrends4, D.J. Feaster5, R. Granich6, B. Marshall7, S.H. Mehta8, L. Metsch9, B.R. Schackman4, S. Shoptaw10, S.A. Strathdee11, B. Nosyk1, on behalf of the Localized Economic Modeling Study Group
Institutions
1BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2Emory University, Rollins School of Public Health, Atlanta, United States, 3University of Washington, Seattle, United States, 4Weill Cornell Medical College, New York, United States, 5University of Miami, Miami, United States, 6International Association of Providers of AIDS Care, Washington, United States, 7Brown School of Public Health, Providence, United States, 8Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, 9Columbia University Mailman School of Public Health, New York, United States, 10University of California Los Angeles, Los Angeles, United States, 11University of California San Diego, San Diego, United States

Background: Simulation modeling plays a critical role in priority setting for HIV treatment and prevention interventions; however, interventions may vary substantially in their ability to deliver value at different levels of scale and in different epidemiological contexts. To inform a U.S. six-city microepidemic HIV transmission model, we executed a targeted literature review to identify plausible ranges of the scale of delivery for a set of evidence-based interventions for the treatment and prevention of HIV/AIDS among adults.
Methods: We identified 14 evidence-based interventions from the US CDC''s Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention and from the recently published literature, ranking the quality of the evidence using the Oxford Centre for Evidence-based Medicine - Levels of Evidence scale. Using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework, we defined the scale of delivery (i.e., the proportion of a target population who are provided with the intervention) as a plausible rate of annual expanded access for HIV prevention programs and as the product of healthcare setting-specific reach and adoption for HIV testing, antiretroviral therapy (ART) engagement, and ART re-engagement interventions.
Results: We synthesized evidence from 11 peer-reviewed publications, 12 public health and surveillance reports, and 3 publicly-available data sets. Plausible annual rates of expanded access ranged from 7%-15% increase for syringe service programs to 74%-107% for pre-exposure prophylaxis (PrEP). Plausible ranges of the scale of delivery for HIV testing interventions ranged from 3%-9% (nurse-initiated) to 19%-51% (opt-out). We estimated ART engagement could reach from 8%-25% (coordinated care) to 29%-84% (EMR-prompt) diagnosed people living with HIVAIDS. The ART re-engagement interventions were estimated to reach from 7%-49% of those who have discontinued ART (Figure 1).
Conclusions: Basing simulation analyses and estimating impacts of evidence-based interventions delivered at feasible levels of implementation is critical to assessing their potential population-level health and economic effectiveness.


Figure 1. Plausible Ranges of Scale of Delivery
[Figure 1. Plausible Ranges of Scale of Delivery]