{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T09:28:42Z","timestamp":1779010122987,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100004726","name":"National Institutes of Health\/National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01-DA-041747"],"award-info":[{"award-number":["R01-DA-041747"]}],"id":[{"id":"10.13039\/501100004726","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Assoc Provid AIDS Care"],"published-print":{"date-parts":[[2019,1,1]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1177\/2325958218821962","type":"journal-article","created":{"date-parts":[[2019,1,22]],"date-time":"2019-01-22T03:49:13Z","timestamp":1548128953000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Why Maximizing Quality-Adjusted Life Years, rather than Reducing HIV Incidence, Must Remain Our Objective in Addressing the HIV\/AIDS Epidemic"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2513-3718","authenticated-orcid":false,"given":"Bohdan","family":"Nosyk","sequence":"first","affiliation":[{"name":"BC Centre for Excellence in HIV\/AIDS, Vancouver, British Columbia, Canada"},{"name":"Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeong Eun","family":"Min","sequence":"additional","affiliation":[{"name":"BC Centre for Excellence in HIV\/AIDS, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Zang","sequence":"additional","affiliation":[{"name":"BC Centre for Excellence in HIV\/AIDS, Vancouver, British Columbia, Canada"},{"name":"Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J.","family":"Feaster","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, Center for Family Studies, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Metsch","sequence":"additional","affiliation":[{"name":"Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0134-7052","authenticated-orcid":false,"given":"Brandon D. L.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Brown School of Public Health, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos Del","family":"Rio","sequence":"additional","affiliation":[{"name":"Hubert Department of Global Health, Emory Center for AIDS Research, Rollins School of Public Health of Emory University, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reuben","family":"Granich","sequence":"additional","affiliation":[{"name":"Independent Public Health Consultant, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce R.","family":"Schackman","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julio S. G.","family":"Montaner","sequence":"additional","affiliation":[{"name":"BC Centre for Excellence in HIV\/AIDS, Vancouver, British Columbia, Canada"},{"name":"Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,1,22]]},"reference":[{"key":"bibr1-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62230-8"},{"key":"bibr2-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61505-X"},{"key":"bibr3-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2009.00515.x"},{"key":"bibr4-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldq033"},{"key":"bibr5-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.12195"},{"key":"bibr6-2325958218821962","unstructured":"National Institute for Health and Care Excellence. The guidelines manual. 2012; https:\/\/www.nice.org.uk\/process\/pmg6\/chapter\/assessing-cost-effectiveness. Updated November, 2012. Accessed January 30, 2017."},{"key":"bibr7-2325958218821962","unstructured":"Edejer TT-T, ebrary Inc. Making choices in health WHO guide to cost-effectiveness analysis. In: Geneva, Switzerland: World Health Organization; 2003: http:\/\/apps.who.int\/iris\/handle\/10665\/42699. Updated July 12, 2012. Accessed January 30, 2017."},{"key":"bibr8-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1007168"},{"key":"bibr9-2325958218821962","unstructured":"White House (US). National HIV\/AIDS Strategy for the United States: Updated to 2020. 2015; https:\/\/files.hiv.gov\/s3fs-public\/nhas-update.pdf. Accessed August 30, 2017."},{"key":"bibr10-2325958218821962","unstructured":"National Institutes of Health. NIH HIV\/AIDS research priorities and guidelines for Determining AIDS Funding. 2015; https:\/\/grants.nih.gov\/grants\/guide\/notice-files\/NOT-OD-15-137.html. Updated August 12, 2015. Accessed January 30, 2017."},{"key":"bibr11-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105243"},{"key":"bibr12-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1627-z"},{"key":"bibr13-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2016.01.011"},{"key":"bibr14-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31976-6"},{"key":"bibr15-2325958218821962","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v9.30314"},{"key":"bibr16-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(16)30051-0"},{"key":"bibr17-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix832"},{"key":"bibr18-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(17)30045-0"},{"key":"bibr19-2325958218821962","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu070"},{"key":"bibr20-2325958218821962","unstructured":"Vancouver Coastal Health. Hope to Health Routine HIV Testing Report. 2015. 2015; http:\/\/www.vch.ca\/Documents\/Q4-2014-Routine-HIV-Testing-Report.pdf. Updated March 31, 2015. Accessed January 30, 2017."},{"key":"bibr21-2325958218821962","unstructured":"Vancouver Coastal Health. STOP HIV\/AIDS Semi-Annual Monitoring Report. 2014. 2014; http:\/\/www.vch.ca\/Documents\/Semi-Annual-HIV-Monitoring-Report-Through-December-31-2013-Final.pdf. Updated May 9, 2014. Accessed January 30, 2017."},{"key":"bibr22-2325958218821962","unstructured":"CATIE. Shifting the paradigm: The history of the Vancouver STOP HIV\/AIDS Project. 2013. 2013; http:\/\/www.catie.ca\/sites\/default\/files\/stop-exec-summary.pdf. Updated October 7, 2013. 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