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Presented by Jason Kessler , M.D., M.P.H No disclosures or conflicts of interest to report

Modeling the impact of focused strategies on the cost and effectiveness of TLC-Plus (or "Test and Treat") in New York City . Kessler, J. Myers, J.E. ; Nucifora, K.A. ; Mensah, N. ; Kowalski, A. ; Sweeney, M. ; Toohey, C. ; Shepard, C. ; Cutler, B. ; Braithwaite, R.S.

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Presented by Jason Kessler , M.D., M.P.H No disclosures or conflicts of interest to report

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  1. Modeling the impact of focused strategies on the cost and effectiveness of TLC-Plus (or "Test and Treat") in New York City Kessler, J. Myers, J.E.; Nucifora, K.A.; Mensah, N.; Kowalski, A.; Sweeney, M.; Toohey, C.; Shepard, C.; Cutler, B.; Braithwaite, R.S. Presented by Jason Kessler , M.D., M.P.H No disclosures or conflicts of interest to report July 23, 2012 IAS 2012

  2. Background and Objectives • Background • HPTN 052 strengthened evidence base for HIV treatment as a prevention strategy • TLC-Plus: community level “test and treat” intervention being tested in HPTN 065 (Bronx, NY and Washington DC) • Objectives • To evaluate the impact of prioritization of TLC-Plus strategies in New York City (NYC). • To identify optimal prioritization strategies for given budget scenarios (i.e. “biggest bang for the buck”)

  3. Methods • Integrated compartmental model (transmission) with microsimulation model (disease progression) • Background Inputs: • HIV testing probability (per year) = 31% • Linkage to care probability (within 90 days) = 75% • Adherence probability= 63% • Intervention effects: • Increases HIV testing probability by 33%, linkage to care by 30% and adherence by 20% in prioritized population • Secondary effects of increased condom usage, and more monogamous relationships • Prioritization strategies compared: • General population (1) • All MSM (3) • All IDU (4) • High risk sexual networks (HR) • all (2) • among MSM (5) • among IDU (6) • among MSM/IDU (7) 1 MSM 3 2 6 7 5 4 IDU High risk sexual networks (HR)

  4. Impact of different prioritization strategies of TLC-Plus over 20 years in NYC % of HIV infections averted New HIV infections % of HIV infections averted Number of new HIV infections

  5. Efficient frontier of prioritization strategies of TLC-Plus General population All high risk sexual networks % HIV infections averted All IDU All MSM High risk sexual networks among IDUs High risk sexual networks among MSM High risk sexual networks among IDU/MSM Total cost over 20 years - US$

  6. Conclusions • TLC-Plus can prevent thousands of new HIV infections in NYC • With conservative assumptions we find more modest impact of TLC-Plus than other models of “test and treat” strategies • Focusing implementation of TLC-Plus among certain subpopulations (or neighborhoods where key subpopulations may concentrate) can render this intervention more cost-effective • Increase in feasibility.

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