Epidemiological Analysis And Health Economical Evaluation Of Scale-up Of Hiv Testing And Antiretroviral Therapy (ART) Among Men Who Have Sex With Men (MSM)

Objective 1.To build the mathematical model of the HIV transmission mode for MSM in China,and predict the AIDS epidemic trends over the next 5 to 10 years(from 2016 to 2025)among MSM and whether the MSM in China will achieve the “90-90-90” target(Targe “90-90-90” would enable 90% of people living with HIV to know their HIV status,90% of people who know their status to access HIV treatment and 90% of people on HIV treatment to achieve viral suppression.)by 2020;2.To evaluate impact of expanding HIV testing,ART and viral load monitoring to AIDS epidemic and “90-90-90” target;3.To evaluate the cost-effectiveness of different schemes including expanding HIV testing,ART and viral load monitoring.Methods This study has collected the relevant parameters affecting the AIDS epidemic among MSM through various channels to establish the mathematical model fitting with the transmission mode of the HIV epidemic among MSM in China,and forecasted the AIDS epidemic trends over the next 5 to 10 years,and used the Monte Carlo method to evaluate the uncertainty of the mathematical model;This study has evaluated the impact of expanding intervention measures on the AIDS epidemic trends over the next 5 to 10 years and whether the MSM in China will reach the “90-90-90” target by 2020;And this study has carried out comparative analysis to evaluate the costs and benefits of different intervention plans,especially the health benefits obtained after scaling up HIV testing,ART and viral load monitoring(such as the number of averted new HIV infection,and the averted HIV/AIDS deaths and the averted DALY),and found out the most cost-effective strategy according to the relationship model combining scope of the incidence of high-risk behavior and the epidemiological results.Results 1.The established mathematical model accurately reflected the past situation of the AIDS epidemic among MSM in China and the acceptance of ART.Mathematical model forecasts that China will maintain the current scale of HIV testing,ART and viral load monitoring and the HIV prevalence of the MSM in China will reach 14.01%(IQR=12.01%-17.59%)by 2020,and reach 18.35%(IQR=16.04%-23.19%)by 2025.Both of them will not meet the “90-90-90” target.2.The mathematical model predicts the impact of the size of HIV testing,ART and viral load monitoring from 2016 to 2025 on AIDS epidemic and the achievement of “90-90-90” target.This study has designed six kinds of different intervention plans(Based on sustaining current size of HIV testing,ART and viral load monitoring,increasing the size of intervention from 2016 to 2025.Plan one: scaling up HIV testing by 100%;Plan two: scaling up HIV testing by 200%;Plan three: scaling up HIV testing by 500%;Plan four: scaling up HIV testing by 500% and ART by 100%;Plan five: scaling up HIV testing by 500%,ART by 200% and viral load monitoring by 100%;Plan six: scaling up HIV testing by 500%,ART by 200% and viral load monitoring by 200%.).According to the predicting results of the mathematical model,scaling up HIV testing will increase the number of new HIV/AIDS infection diagnosed from 2016 to 2025 and achieve the first “90” target more easily;Scaling up ART will reduce the HIV/AIDS deaths among the MSM in China and achieve the second “90” target more easily;At the same time,scaling up HIV testing,ART and viral load monitoring can control the future AIDS epidemic,increase the number of ART and achieve the “90-90-90” target more easily.Based on sustaining current size of intervention,increasing the size of intervention from 2016 to 2025,there will be 500% increase in HIV testing,200% increase in ART and 200% increase in viral-load monitoring(plan six),and the “90-90-90” target will be basically implemented by 2025.3.Based on the cost-effectiveness analysis of six different intervention plans,it is predicted that compared with maintaining the current size of HIV testing,ART and viral load monitoring,from 2016 to 2025,the costs for six different intervention plans to avert per case of new HIV infection,per case of HIV/AIDS death,per DALY,the costs for plan one respectively are $3516,$3699 and $668.The costs for plan two respectively are $3453,$3679 and $662.The costs for plan three respectively are $3333,$3685 and $655.The costs for plan four respectively are $3004,$3766 and $656.The costs for plan five respectively are $3848,$5037 and $866.The costs for plan six respectively are $4486,$5970 and $91024.Thus the plan four will be the most cost-effective plan.Conclusions On the basis of maintaining the current scale of intervention,the AIDS epidemic among MSM in China will continue to rise in the next five to ten years,and the “90-90-90” target,will not be able to achieved.HIV testing,ART and viral load monitoring are the important measures of preventing and controlling AIDS among MSM in China.Therefore,it is necessary to scale up HIV testing,ART and viral load monitoring to control the future AIDS epidemic among MSM and realize the target of “90-90-90”.