Why Maximizing Quality-Adjusted Life Years, rather than Reducing HIV Incidence, Must Remain Our Objective in Addressing the HIV/AIDS Epidemic

• Main Authors: Bohdan Nosyk PhD, Jeong Eun Min MSc, Xiao Zang MSc, Daniel J. Feaster PhD, Lisa Metsch PhD, Brandon D. L. Marshall PhD, Carlos Del Rio MD, Reuben Granich PhD, Bruce R. Schackman PhD, Julio S. G. Montaner MD
• Format: Article
• Language: English
• Published: SAGE Publishing 2019-01-01
• Series: Journal of the International Association of Providers of AIDS Care
• Online Access: https://doi.org/10.1177/2325958218821962

With efficacious behavioral, biomedical, and structural interventions available, combination implementation strategies are being implemented to combat HIV/AIDS across settings internationally. However, priority statements from national and international bodies make it unclear whether the objective should be the reduction in HIV incidence or the maximization of health, most commonly measured with quality-adjusted life years (QALYs). Building off a model-based evaluation of HIV care interventions in British Columbia, Canada, we compare the optimal sets of interventions that would be identified using HIV infections averted, and QALYs as the primary outcome in a cost-effectiveness analysis. We found an explicit focus on averting new infections undervalues the health benefits derived from antiretroviral therapy, resulting in suboptimal and potentially harmful funding recommendations.