{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T02:03:22Z","timestamp":1774490602038,"version":"3.50.1"},"reference-count":45,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T00:00:00Z","timestamp":1565222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2019,11]]},"abstract":"Objectives<\/jats:title>Early treatment of HIV<\/jats:styled-content>\u20101 infection at all CD<\/jats:styled-content>4 levels has demonstrated clinical and public health benefits. This analysis examined the costs, health outcomes, and cost\u2010effectiveness of increased HIV<\/jats:styled-content>\u20101 screening and early treatment initiation in the UK<\/jats:styled-content>.<\/jats:p><\/jats:sec>Methods<\/jats:title>A Markov model followed theoretical cohorts of men who have sex with men (MSM<\/jats:styled-content>), heterosexuals, and people who inject drugs (PWID<\/jats:styled-content>) with initially undiagnosed HIV<\/jats:styled-content>\u20101 infection over their remaining lifetimes. The analysis examined increased HIV<\/jats:styled-content>\u20101 screening (resulting in 10\u201350% improvements in diagnosis rates) versus current screening in sexual health services (SHS<\/jats:styled-content>) and other settings, with all individuals initiating treatment within 3\u00a0months of diagnosis. Health status was modelled by viral load and CD<\/jats:styled-content>4 cell count as individuals progressed to diagnosis and treatment. Individuals accrued quality\u2010adjusted life\u2010years (QALY<\/jats:styled-content>s), incurred costs for screening and HIV<\/jats:styled-content>\u2010related clinical management, and were at risk of transmitting HIV<\/jats:styled-content>\u20101 infection to their partners. Input parameter data were taken primarily from UK<\/jats:styled-content>\u2010specific published sources. All outcomes were discounted at 3.5% annually.<\/jats:p><\/jats:sec>Results<\/jats:title>The model estimated that increased screening and early treatment resulted in fewer onward HIV<\/jats:styled-content> transmissions, more QALY<\/jats:styled-content>s, and higher total costs. For SHS<\/jats:styled-content>, incremental cost\u2010effectiveness ratios (ICER<\/jats:styled-content>s) for heterosexuals (~\u00a322\u00a0000\/QALY<\/jats:styled-content> gained) were within typical UK<\/jats:styled-content> willingness\u2010to\u2010pay thresholds and were well below these thresholds for MSM<\/jats:styled-content> (~\u00a39500\/QALY<\/jats:styled-content> gained) and PWID<\/jats:styled-content> (~\u00a36500\/QALY<\/jats:styled-content> gained). Sensitivity analysis showed that model results were robust.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Increased HIV<\/jats:styled-content>\u20101 screening and early treatment initiation may be a cost\u2010effective strategy to reduce HIV<\/jats:styled-content> transmission and improve health for MSM<\/jats:styled-content>, heterosexuals, and PWID<\/jats:styled-content> in the UK<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12788","type":"journal-article","created":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T08:37:55Z","timestamp":1565253475000},"page":"668-680","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Is\u00a0increased screening and early antiretroviral treatment for HIV<\/scp>\u20101 worth the investment?\u00a0An analysis of the public health and economic impact of improvement\u00a0in the UK<\/scp>"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9003-994X","authenticated-orcid":false,"given":"AJ","family":"Brogan","sequence":"first","affiliation":[{"name":"RTI Health Solutions Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SE","family":"Talbird","sequence":"additional","affiliation":[{"name":"RTI Health Solutions Research Triangle Park NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"AE","family":"Davis","sequence":"additional","affiliation":[{"name":"RTI Health Solutions Research Triangle Park NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Wild","sequence":"additional","affiliation":[{"name":"Gilead Sciences Ltd London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Gilead Sciences Ltd London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506816"},{"key":"e_1_2_7_3_1","unstructured":"British HIV Association.British HIV Association Guidelines for the Treatment of HIV\u20101\u2010Positive Adults with Antiretroviral Therapy 2015. 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