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An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings

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Published on: March 30, 2014

Optimizing resource allocation in United States AIDS drug assistance programs.

Benjamin P Linas¹, Hui Zheng, Elena Losina

¹Division of General Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. blinas@partners.org

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America

|October 20, 2006

Summary

Implementing CD4 cell count criteria for AIDS Drug Assistance Programs (ADAPs) can serve more diverse populations with advanced HIV, optimizing limited resources. This approach prioritizes at-risk individuals, improving health outcomes compared to first-come, first-served methods.

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Area of Science:

Public Health
HIV/AIDS Management
Health Economics

Background:

US AIDS Drug Assistance Programs (ADAPs) face fiscal crises, leading to waiting lists and first-come, first-served client prioritization.
Current ADAP models may not effectively serve diverse, at-risk populations due to resource limitations.
Hypothesis: CD4 cell count-based eligibility can improve ADAP outcomes and equity.

Purpose of the Study:

To evaluate the impact of CD4 cell count-based eligibility criteria versus first-come, first-served for ADAP.
To assess effects on patient demographics, disease severity, and resource allocation.
To determine if CD4 criteria can optimize service for high-risk HIV/AIDS patients.

Main Methods:

Retrospective cohort analysis of Massachusetts ADAP administrative data from fiscal year 2003.
Model-based analysis to simulate eligibility criteria (CD4 count < or = 350 cells/microL vs. first-come, first-served).
Comparison of client characteristics, including CD4 counts, race, language, and employment status.

Main Results:

CD4 count-based eligibility would have served 37% fewer clients, yielding $2.7 million savings, compared to 32% fewer clients under first-come, first-served.
CD4 criteria prioritized patients with lower median CD4 counts (257 cells/microL) over those with higher counts (659 cells/microL).
CD4-based enrollment served a greater proportion of nonwhite (65% vs 55%), non-English speaking (24% vs 19%), and unemployed (69% vs 61%) individuals.

Conclusions:

CD4 cell count-based enrollment criteria enable ADAPs to serve more diverse populations with advanced HIV disease under resource constraints.
This approach is more equitable and effective in prioritizing individuals at greatest risk of mortality compared to first-come, first-served.
Shifting to CD4 criteria optimizes ADAP resource allocation for improved patient outcomes.