Projecting the clinical and economic impacts of changes to HIV care among adolescents and young adults in the US: lessons from the COVID-19 pandemic

Document Type

Journal Article

Publication Date

11-14-2023

Journal

Journal of the Pediatric Infectious Diseases Society

DOI

10.1093/jpids/piad102

Keywords

COVID-19; HIV; adolescents and young adults; telehealth; youth

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 three 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 one-year retention (87% vs. 80%) and lower cost/visit ($49 vs. $56) for Telehealth vs. Clinic. We modeled two 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 and costs/100 YHIV over 10 years. RESULTS: Over 10 years, life-months in Clinic and Telehealth would be similar (YNPHIV: 11,350 vs. 11,360 life-months; YPHIV: 11,680 life-months for both strategies); costs would be $0.3M (YNPHIV) and $0.4M (YPHIV) more for Telehealth than Clinic. Interruption would be less effective (YNPHIV: 11,230 life-months; YPHIV: 11,620 life-months) 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.

Department

Pediatrics

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