Table 1.
Description | Value | Source |
---|---|---|
Number of individuals in susceptible compartment i at time t (initial [1996]a value) | 2.64M | [14, 20, 21, 22] |
Number of individuals in HIV-infected (undiagnosed) compartment i at time t (initial value) | 3694 | [14, 22, 23] |
Number of individuals in HIV-diagnosed compartment i at time t (initial value) | 3844 | [14, 22, 23] |
Number of individuals in HIV treatment compartment i at time t (initial value) | 0 | [14, 22, 23] |
Number of individuals in HIV off-treatment compartment i at time t (initial value) | 0 | [14, 22, 23] |
Monthly entry rate of individuals into compartment i | Time-varying | [20] |
Average duration uninfected individuals in compartment i remain “identified” after screening | 12 months | Assumption |
Monthly HIV screening rate for individuals in compartment i | Figure 1 | [1] |
High risk (PWID, MSM/PWID) (multiplier) | 2.6 | [24] |
Total sufficient contact rate | Time-varying | [3–6, 16, 21, 25, 26, 27–56] |
Mortality and maturation rate for individuals in compartment i | ||
Monthly mortality rate: heterosexual (susceptible) | 0.00027 | [57] |
Monthly mortality rate: MSM (susceptible) | 0.00034 | [57] |
Monthly mortality rate: PWID (susceptible) | 0.00238 | [27] |
Monthly mortality rate: MSM/PWID (susceptible) | 0.00246 | [27] |
Monthly mortality rate: heterosexual (infected/diagnosed) | ||
CD4: ≥500 | 0.00079 | [58] |
CD4: 350–499 | 0.00079 | [58] |
CD4: 200–349 | 0.00136 | [59] |
CD4: <200 | 0.00853 | [18] |
Monthly mortality rate: MSM (infected/diagnosed) | ||
CD4: ≥500 | 0.00045 | [28] |
CD4: 350–499 | 0.00045 | [58] |
CD4: 200–349 | 0.00175 | [59] |
CD4: <200 | 0.00853 | [18] |
Monthly mortality rate: PWID, including MSM/PWID (infected/diagnosed) | ||
CD4: ≥500 | 0.00250 | [58] |
CD4: 350–499 | 0.00250 | [58] |
CD4: 200–349 | 0.00357 | [59] |
CD4: <200 | 0.00856 | [18] |
Monthly mortality rate: on ART (×1000–1) | Time-varying | [14, 22, 23] |
Non-PWID | ||
CD4: ≥500 | 0.474 (1996); 0.399 (2010) | |
CD4: 350–499 | 0.608 (1996); 0.541 (2010) | |
CD4: 200–349 | 1.167 (1996); 1.043 (2010) | |
CD4: <200 | 8.259 (1996); 7.883 (2010) | |
PWID | ||
CD4: ≥500 | 0.973 (1996); 0.833 (2010) | |
CD4: 350–499 | 1.181 (1996); 1.078 (2010) | |
CD4: 200–349 | 2.557 (1996); 2.354 (2010) | |
CD4: <200 | 8.288 (1996); 8.021 (2010) | |
Monthly maturation rate | 0.00125 | [20] |
Symptom-based monthly case finding rate for infected individuals in compartment i | ||
Low risk (CD4: 200–349) | 0.00874 | [60] |
High risk (CD4: <200) | 0.01842 | [60] |
HIV disease progression rate for individuals not on ART | [19, 60–62] | |
CD4: ≥500 to CD4: 350–499 | 0.02209 | |
CD4: 350–499 to CD4: 200–349 | 0.02209 | |
CD4: 200–349 to CD4 <200 | 0.02209 | |
CD4: <200 to death | 0.00250 | |
HIV disease progression rate for individuals on ART in compartment i | Supplementary Materials, Figure A6 | [14, 22, 23] |
Rate of ART discontinuation | Figure 2, panels E and F | [14, 22, 23] |
Probability of direct ART initiations immediately after diagnosis | Supplementary Materials, Figure A4 | [14, 22, 23] |
Rate of individuals from diagnosed compartment i initiating antiretroviral treatment | Figure 2, panels A and B | [14, 22, 23] |
Rate of ART reinitiation among those who had discontinued treatment | Figure 2, Panels C and D | [14, 22, 23] |
Indicator variable for eligibility for HIV treatment initiation | Time-varying | [63, 64, 65–71] |
1996–1997 | CD4 <500 | |
1998–2001 | CD4 <350 | |
2002–2003 | CD4 <200 | |
2004–2007 | CD4 <350 | |
2008–2010 | CD4 <500 | |
Post-2011 | All CD4 | |
HIV transmission parameter | ||
Needle-sharing parameters | ||
Number of injections (monthly) at baseline | 19.5 | [21, 26] |
Reduced injections due to opioid agonist treatment | 0.75 | [27, 72] |
Probability of shared injection at baseline | 0.21 | [21, 28] |
Probability of transmission per shared injection: CD4 >500 | 0.002 | [27, 29, 30] |
Probability of transmission per shared injection: CD4: 350–499 | 0.002 | |
Probability of transmission per shared injection: CD4: 200–349 | 0.003 | |
Probability of transmission per shared injection: CD4 <200 | 0.003 | |
Reduced probability of transmission on ART | 0.9 | [4] |
Homosexual sex parameters | ||
No sexual partners (annual) | 2.7 | [16, 21, 31] |
Condom use probability | 0.5 | [25, 32–36] |
Probability of transmission: CD4: >500 | 0.04 | [16, 37–40] |
Probability of transmission: CD4: 350–499 | 0.04 | |
Probability of transmission: CD4: 200–349 | 0.05 | |
Probability of transmission: CD4: <200 | 0.1 | |
Reduced probability of transmission on ART | 0.96 | [6] |
Decreased number of sexual partners due to diagnosis | 0.5 | [41–44 |
Condom effectiveness | 0.9 | [45] |
Heterosexual sex parameters | ||
No sexual partners: MSM | 0.08 | [32] |
No sexual partners: MSM/PWID | 0.08 | [46, 47] |
No sexual partners: PWID | 1.6 | [47, 48] |
No sexual partners: heterosexual | 0.9 | [32, 49–51] |
Condom use probability: MSM | 0.3 | [34, 36, 46] |
Condom use probability: MSM/PWID | 0.3 | |
Condom use probability: PWID | 0.3 | [35, 46] |
Condom use probability: heterosexual | 0.3 | [51] |
Probability of transmission: CD4: >500 | 0.025 | [3, 37, 52–56] |
Probability of transmission: CD4: 350–499 | 0.025 | |
Probability of transmission: CD4: 200–349 | 0.035 | |
Probability of transmission: CD4: <200 | 0.065 | |
Decreased number of sexual partners due to diagnosis | 0.5 | [44] |
Reduced probability of transmission on ART | 0.96 | [5] |
Condom effectiveness | 0.9 | [45] |
Costs (2015$CDN) | ||
ART costsc: PWID | Time dependentb | [73] |
CD4: >500 | 435 (1996); 1276 (2010) | |
CD4: 350–499 | 464 (1996); 1287 (2010) | |
CD4: 200–349 | 483 (1996); 1287 (2010) | |
CD4: <200 | 478 (1996); 1294 (2010) | |
ART costsc: non-PWID | Time dependentb | [73] |
CD4: >500 | 494 (1996); 1295 (2010) | |
CD4: 350–499 | 523 (1996); 1306 (2010) | |
CD4: 200–349 | 542 (1996); 1305 (2010) | |
CD4: <200 | 537 (1996); 1313 (2010) | |
Non-ART medical costsd: PWID | Time dependentb | [74] |
CD4: >500 | 788 (1996); 745 (2010) | |
CD4: 350–499 | 825 (1996); 784 (2010) | |
CD4: 200–349 | 883 (1996); 1022 (2010) | |
CD4: <200 | 1896 (1996); 1992 (2010) | |
Non-ART medical costsd: non-PWID | Time dependentb | [74] |
CD4: >500 | 317 (1996); 309 (2010) | |
CD4: 350–499 | 362 (1996); 330 (2010) | |
CD4: 200–349 | 471 (1996); 471 (2010) | |
CD4: <200 | 1098 (1996); 763 (2010) | |
HIV enzyme-linked immunosorbent assay antibody test | 13 | [75] |
Confirmatory Western blot test | 21 | [75] |
Medical care costsd: HIV-negative, MSM | 205 | [76] |
Medical care costsd: HIV-negative, PWID | 518 | [73, 76] |
Medical care costsd: HIV-negative, heterosexual | 217 | [76] |
Intervention costse | Appendix | |
Hospital-based care testing | 32081 (IMP); 12750 (SUS) | |
Emergency department testing | 42798 (IMP); 9892 (SUS) | |
Outpatient clinic testing | 49215 (IMP); 14785 (SUS) | |
ART initiation | 66922 (IMP); 32271 (SUS) | |
ART retention | 230734 (IMP); 111263 (SUS) | |
Annual discount rate | 0.03 | |
Quality-adjusted life years | ||
Susceptible | 1.00 | [77] |
Infected: CD4: ≥500 | 0.91 | [78–81] |
Infected: CD4: 350–499 | 0.79 | [78–81] |
Infected: CD4: 200–349 | 0.79 | [78–81] |
Infected: CD4: <200 | 0.72 | [78–81] |
Diagnosed: CD4: ≥500 | 0.87 | [78–81] |
Diagnosed: CD4: 350–499 | 0.72 | [78–81] |
Diagnosed: CD4: 200–349 | 0.72 | [78–81] |
Diagnosed: CD4: <200 | 0.72 | [78–81] |
On ART: CD4>500 | 0.87 | [78–81] |
On ART: CD4: 350–499 | 0.83 | [78–81] |
On ART: CD4: 200–349 | 0.83 | [78–81] |
On ART: CD4: <200 | 0.82 | [78–81] |
PWID multiplier | 0.90 | [27, 82] |
Abbreviations: ART, highly active antiretroviral treatment; CDN, Canadian dollars; HIV, human immunodeficiency virus; IMP, implementation phase; MSM, men who have sex with men; PWID, people who inject drugs; SUS, sustainment phase.
“Initial” values refer to 1996 values, the start of the model calibration period (1996–2010).
Figures presented for time-dependent parameters are 1996 and 2010 values.
Includes ART medication costs and associated pharmacy dispensation costs.
Includes non-ART medication costs and associated pharmacy dispensation costs, costs of physician billings for outpatient care, and hospitalization cost.
Intervention costs were differentiated between the implementation phase and the sustainment phase, with the latter excluding fixed costs of initiating the interventions.