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

Authors

Isaac Ravi Brenner, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.
Kit N. Simpson, Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC.
Clare F. Flanagan, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.
Tyra Dark, Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Sciences, Florida State University College of Medicine, Tallahassee, FL.
Mary Dooley, Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC.
Allison L. Agwu, Department of Pediatrics and Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.
Wei Li Koay, Division of Infectious Diseases, Children's National Hospital, Washington, DC.
Kenneth A. Freedberg, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.
Andrea L. Ciaranello, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.
Anne M. Neilan, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.

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.

APA Citation

Brenner, Isaac Ravi; Simpson, Kit N.; Flanagan, Clare F.; Dark, Tyra; Dooley, Mary; Agwu, Allison L.; Koay, Wei Li; Freedberg, Kenneth A.; Ciaranello, Andrea L.; and Neilan, Anne M., "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" (2023). GW Authored Works. Paper 3808.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3808

Department

Pediatrics