to reduce the public health burden of HIV
/AIDS can vary in their ability to deliver value at different levels of scale and in different epidemiological contexts. Our objective was to determine the cost-effectiveness
treatment and prevention interventions
implemented at previously documented scales of delivery in six US cities with diverse HIV
Design: Dynamic HIV transmission model
We identified and estimated previously documented scale of delivery and costs for 16 evidence-based interventions
from the US CDC's Compendium of Evidence-Based Interventions
and Best Practices for HIV
Prevention. Using a model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City and Seattle, we estimated averted HIV
infections, quality-adjusted life years (QALY) gained and incremental cost-effectiveness
ratios (healthcare perspective; 3% discount rate, 2018$US), for each intervention and city (10-year implementation
) compared with the status quo over a 20-year time horizon.
testing was cost-saving or cost-effective across cities. Targeted preexposure prophylaxis for high-risk MSM was cost-saving in Miami and cost-effective in Atlanta ($6123/QALY), Baltimore ($18 333/QALY) and Los Angeles ($86 117/QALY). Interventions
designed to improve antiretroviral therapy initiation provided greater value than other treatment engagement interventions
. No single intervention was projected to reduce HIV
incidence by more than 10.1% in any city.
strategies should be tailored to local epidemiological contexts to provide the most value. Complementary strategies addressing factors hindering access to HIV
care will be necessary to meet targets for HIV
elimination in the United States.