Clinical, Economic Impact of Adherence Interventions Among Youth With HIV

Anne M Neilan, MD, MPH, medicine and pediatrics-trained adult infectious disease physician at Massachusetts General Hospital and instructor at Harvard Medical School, explains the results of her recent study that examined the impact of a hypothetical adherence intervention in order to identify combinations of effectiveness and cost at which these programs would be cost-effective for youth with HIV. 

What existing data led you and your co-investigators to conduct this research? 

Youth with HIV do you more poorly than adults at each step of the HIV care continuum from diagnosis, linkage to care, retention in care and virologic suppression. Only approximately a quarter of youth ages 13-24 with HIV are virologically suppressed. Those who are not virologically suppressed miss opportunities for improved individual health, and may also contribute to HIV transmission.  The CDC estimates that the highest rate of onward HIV transmissions by age arises among AYA with HIV (Li MMWR 2019).  

Improving virologic suppression among youth with HIV is a focus of several Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) protocols.  

As these studies were starting to enroll, we asked, for these and other adherence interventions we asked:  

• How well do they have to work?
• How long do they need to last?
• How much can they cost?
• In order to be of good value for youth with HIV in the US?

These questions were asked with the goal of informing recommendations for clinical practice. 

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?

The objective of the analysis was to model the impact of a hypothetical adherence intervention, based on electronic reminders— such as text messages— to identify combinations of effectiveness and cost at which these programs would be cost-effective for youth with HIV. We found that interventions generating small improvements in virologic suppression may improve clinical outcomes and be cost effective. 

We further found that the hypothetical intervention-specific costs amounted to <1% of a patient’s overall costs of a patient’s HIV-related lifetime costs. We also found that efforts to reduce drug costs, such as improved access to generics, could further improve the value of adherence interventions. 

What are the possible real-world applications of these findings in clinical practice? 

These are meaningful results for investigators and clinicians who work with youth with HIV. Even adherence interventions that lead to small improvements in a patient’s virologic suppression and CD4 cell count may have important health benefits across a lifetime and be cost-effective. 

Do you and your co-investigators intend to expand upon this research? 

We look forward to continuing our work with the ATN to project the long-term clinical and economic impact of interventions to improve the health of youth with HIV. 

Is there anything else pertaining to your research and findings that you would like to add?

Thank you for shining a spotlight on this work!

About Anne M Neilan, MD, MPH

Dr Neilan is a medicine and pediatrics-trained adult infectious disease physician at Massachusetts General Hospital and an Instructor at Harvard Medical School. Her research interests include the use of simulation modeling and cost-effectiveness analysis to inform care strategies for adolescents with HIV and at risk of HIV. She is also the Director of the Modeling Core for the national Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN 161). She earned her MD and MPH from The Mount Sinai School of Medicine in New York.  

Reference:

Neilan AM, Bangs AC, Hudgens M, et al. Modeling Adherence Interventions Among Youth with HIV in the United States: Clinical and Economic Projections [published online ahead of print, 2021 Feb 6]. AIDS Behav. 2021;10.1007/s10461-021-03169-0. doi:10.1007/s10461-021-03169-0