{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T17:13:06Z","timestamp":1767978786606,"version":"3.49.0"},"reference-count":26,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2018,7,1]],"date-time":"2018-07-01T00:00:00Z","timestamp":1530403200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["U01AA021990-01"],"award-info":[{"award-number":["U01AA021990-01"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["MDM Policy &amp; Practice"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:p> Background. Multilevel interventions combine individual component interventions, and their design can be informed by decision analysis. Our objective was to identify the optimal combination of interventions for alcohol-using HIV+ individuals on antiretroviral drug therapy in Maharashtra, India, explicitly considering stakeholder constraints. Methods. Using an HIV simulation, we evaluated the expected net monetary benefit (ENMB), the probability of lying on the efficiency frontier (PEF), and annual program costs of 5,836 unique combinations of 15 single-focused HIV risk-reduction interventions. We evaluated scenarios of 1) no constraints (i.e., maximize expected value), 2) short-term budget constraints (limits on annual programmatic costs of US$200,000 and $400,000), and 3) a constraint stemming from risk aversion (requiring that the strategy has &gt;50% PEF). Results. With no constraints, the combination including long individual alcohol counseling, text-message adherence support, long group counseling for sex-risk, and long individual counseling for sex-risk (annual cost = $428,886; PEF \u223c27%) maximized ENMB and would be the optimal design. With a cost constraint of $400,000, the combination including long individual alcohol counseling, text-message adherence support, brief group counseling for sex-risk, and long individual counseling for sex-risk (annual cost = $374,745; PEF \u223c4%) maximized ENMB. With a cost constraint of $200,000, the combination including long individual alcohol counseling, text-message adherence support, and brief group counseling for sex-risk (annual cost = $187,335; PEF \u223c54%) maximized ENMB. With the risk aversion constraint, the same configuration ( long individual alcohol counseling, text-message support, and brief group counseling for sex-risk) maximized health benefit. Conclusion. Evaluating the costs, risks, and projected benefits of alternatives supports informed decision making prior to initiating study; however, stakeholder constraints should be explicitly included and discussed when using decision analyses to guide study design. <\/jats:p>","DOI":"10.1177\/2381468318803940","type":"journal-article","created":{"date-parts":[[2018,10,17]],"date-time":"2018-10-17T05:08:36Z","timestamp":1539752916000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluating Alternative Designs of a Multilevel HIV Intervention in Maharashtra, India: The Impact of Stakeholder Constraints"],"prefix":"10.1177","volume":"3","author":[{"given":"Anik R.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"Department of Population Health, New York University School of Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly V.","family":"Ruggles","sequence":"additional","affiliation":[{"name":"Department of Population Health, New York University School of Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Nucifora","sequence":"additional","affiliation":[{"name":"Department of Population Health, New York University School of Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinlian","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Population Health, New York University School of Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Schensul","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Health Care, University of Connecticut, Storrs, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean","family":"Schensul","sequence":"additional","affiliation":[{"name":"Institute of Community Research, Hartford, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kendall","family":"Bryant","sequence":"additional","affiliation":[{"name":"National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Scott","family":"Braithwaite","sequence":"additional","affiliation":[{"name":"Department of Population Health, New York University School of Medicine, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,10,16]]},"reference":[{"key":"bibr1-2381468318803940","unstructured":"World Health Organization. Treat all people living with HIV, offer antiretrovirals as additional prevention choice for people at \u201csubstantial\u201d risk [cited June10, 2016]. Available from: http:\/\/www.who.int\/mediacentre\/news\/releases\/2015\/hiv-treat-all-recommendation\/en\/"},{"key":"bibr2-2381468318803940","volume-title":"Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Recommendations for a Public Health Approach","author":"World Health Organization","year":"2016","edition":"2"},{"key":"bibr3-2381468318803940","unstructured":"International Institute for Population Sciences. National Family Health Survey, India 2005-06 NFHS-3 [cited July 11, 2016]. 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