MedicalResearch.com Interview with:
Cora Bernard, MS, PhD candidate
Pre-doctoral Student in Management Science and Enginnering
Affiliate, Center for Health Policy and the Center for Primary Care and Outcomes Research
Stanford Health Policy
MedicalResearch.com: What is the background for this study?
Response: The US opioid epidemic is leading to an increase in the US drug-injecting population, which also increases the risks of HIV transmission. It is critical to public health that the US invests in a coherent and cost-effective suite of HIV prevention programs. In our model-based analysis, we considered programs that have the potential both to prevent HIV and to improve long-term health outcomes for people who inject drugs. Specifically, we evaluated opioid agonist therapy, which reduces the frequency of injection; needle and syringe exchange programs, which reduce the frequency of injecting equipment sharing; enhanced HIV screening and antiretroviral therapy programs, which virally suppress individuals and decrease downstream transmission; and oral HIV pre-exposure prophylaxis (PrEP), which is taken by an uninfected individual and lowers the risk of infection.
MedicalResearch.com: What are the main findings?
Response: We project that opioid agonist therapy, which provides immediate quality of life improvements in addition to lowering HIV risk, is the most cost-effective intervention. Needle and syringe exchange programs are less expensive and offer good value in combination with opioid agonist therapy. Testing and treatment programs are cost-effective although we do not identify them as the priority investment in this population. We find that PrEP is unlikely to provide high value in the injecting population even though it is effective at preventing HIV.
MedicalResearch.com: What should readers take away from your report?
Response: Because of the high competing mortality risks among PWID, decreasing injection drug use directly pays more health dividends than simply preventing HIV alone, which is why opioid agonist therapy achieves highest value in our model. Prevention programs for the injecting population can be controversial and access to programs like needle syringe exchange and opioid agonist therapy, in particular, remains limited. Nonetheless, we demonstrate that these programs can provide cost-effective ways not only to prevent HIV transmission but also to reduce the size of the injecting population, thereby lessening the personal and social costs of the opioid epidemic.
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Cora L. Bernard, Douglas K. Owens, Jeremy D. Goldhaber-Fiebert, Margaret L. Brandeau. Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis. PLOS Medicine, 2017; 14 (5): e1002312 DOI: 10.1371/journal.pmed.1002312
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