Projecting the Clinical and Economic Impacts of Changes to HIV Care Among Adolescents and Young Adults in the United States: Lessons From the COVID-19 Pandemic.
J Pediatric Infect Dis Soc
; 13(1): 60-68, 2024 Jan 29.
Article
em En
| MEDLINE
| ID: mdl-37963069
ABSTRACT
BACKGROUND:
During the COVID-19 pandemic, many US youth with HIV (YHIV) used telehealth services; others experienced disruptions in clinic and antiretroviral therapy (ART) access.METHODS:
Using the Cost-effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent HIV microsimulation model, we evaluated 3 scenarios 1) Clinic in-person care; 2) Telehealth virtual visits, without CD4 or viral load monitoring for 12 months, followed by return to usual care; and 3) Interruption complete care interruption with no ART access or laboratory monitoring for 6 months (maximum clinic closure time), followed by return to usual care for 80%. We assigned higher 1-year retention (87% vs 80%) and lower cost/visit ($49 vs $56) for Telehealth vs Clinic. We modeled 2 YHIV cohorts with non-perinatal (YNPHIV) and perinatal (YPHIV) HIV, which differed by mean age (22 vs 16 years), sex at birth (85% vs 47% male), starting CD4 count (527/µL vs 635/µL), ART, mortality, and HIV-related costs. We projected life months (LMs) and costs/100 YHIV over 10 years.RESULTS:
Over 10 years, LMs in Clinic and Telehealth would be similar (YNPHIV 11â 350 vs 11â 360 LMs; YPHIV 11â 680 LMs for both strategies); costs would be $0.3M (YNPHIV) and $0.4M (YPHIV) more for Telehealth than Clinic. Interruption would be less effective (YNPHIV 11â 230 LMs; YPHIV 11â 620 LMs) and less costly (YNPHIV $1.3M less; YPHIV $0.2M less) than Clinic. Higher retention in Telehealth led to increased ART use and thus higher costs.CONCLUSIONS:
Telehealth could be as effective as in-person care for some YHIV, at slightly increased cost. Short interruptions to ART and laboratory monitoring may have negative long-term clinical implications.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Telemedicina
/
Fármacos Anti-HIV
/
COVID-19
Limite:
Adolescent
/
Adult
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Female
/
Humans
/
Male
/
Newborn
/
Pregnancy
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article