Vaccine equity: What we know and what we need to do and how implementation research can help

Lisa Hirschhorn, MD, MPH
Northwestern University

Rebecca Weintraub, MD
Harvard University

ABSTRACT:
The COVID-19 pandemic has brought the spotlight on inequities in health care access and outcomes. While the rapid development of highly effective vaccines offers the opportunity to end the pandemic, the concerns, and emerging evidence in inequity to access as well as acceptability threatens to increase these disparities. Implementation research offers tools and approaches to help understand underlying determinants and inform strategies that need to be put into place to prevent worsening of the existing inequity.

To request Dr. Hirschhorn and Dr. Weintraub’s powerpoint slides, please email psmg@northwestern.edu

Localized Economic Modeling to Support Implementation of the “Ending the HIV Epidemic in America” Initiative

Bohdan Nosyk, PhD, MA
Simon Fraser University

ABSTRACT:
Rather than a homogeneous national epidemic, the HIV epidemic in the US is a collection of diverse local microepidemics concentrated primarily in the South, hotspot counties, and large urban centers, with fundamental differences in health system infrastructure, funding and HIV-related laws and policies. Recognizing these facts, the US launched the ambitious ‘Ending the HIV Epidemic (EHE) initiative in February 2019. The plan called for an initial focus on 48 of the most-affected counties plus Washington, DC, San Juan, Puerto Rico and seven southern states to reduce new infections by 75% within 5 years and by 90% within 10 years. These goals are now challenged by the onset of the global COVID-19 pandemic, which may have severe consequences for people living with HIV and on HIV microepidemics across the US. A value-based approach, accounting for the pervasive racial/ethnic inequities in healthcare access and explicating key elements of the implementation process are now more critical than ever in reaching the ambitious targets of the EHE initiative.

In 2016 our investigative team began a project aiming to identify optimal combination implementation strategies to reduce the public health burden of HIV/AIDS in six US cities (NIH-DA-041747). These six cities, all subsequently included in the EHE initiative, comprised 12 of 48 EHE-targeted counties and 24.1% of people living with HIV/AIDS in the nation. Considering the impact of 16 evidence-based interventions to Diagnose, Treat and Protect against HIV/AIDS, we found unique combination implementation strategies provided the greatest health benefits in each city; no two cities featured the same mix of interventions in their ‘optimal’ strategy. Moreover, we found the EHE goals were attainable in three of six cities. The biomedical interventions we considered would however have to be delivered at ideal levels of implementation, which would require additional efforts to reduce barriers in access to care and explicitly focus on reducing disparities in healthcare access among Black and Hispanic communities. We argue that promoting health equity is key to bridging this implementation gap and propose an approach to establish an equitable distribution of resources to maximize the impact of the EHE initiative.

Health Economic Research Supporting the U.S. Response to the Opioid Crisis: Defining Cost Effective Interventions and Implementation Strategies

Kathryn McCollister, Phd
University of Miami, Miller School of Medicine

ABSTRACT:
As the U.S. continues to grapple with the opioid epidemic, the National Institutes of Health, in collaboration with the Substance Abuse and Mental Health Services Administration, has recently launched several funding initiatives tasked with identifying, testing, and implementing evidence-based strategies to significantly reduce overdose fatalities and other negative consequences associated with opioid use disorders (OUD). Health economics research is highlighted as an important component to these new studies; specifically, the need for economic data informing resource allocation, cost effectiveness, and financing mechanisms that support the feasibility and sustainability of recommended strategies. This talk will describe the current state of knowledge on the cost effectiveness of treatment interventions and other strategies for OUD as well as relatively new questions relating to the economics of implementation at a broader community- or systems-level.

Title: Cost-Effectiveness of Care Models to Support HCV and HIV Elimination in People Who Inject Drugs

Bruce Schackman, Phd
Weill Cornell Medical College

ABSTRACT:
The United States has set ambitious goals to eliminate Hepatitis C Virus (HCV) and HIV infections nationally, but the current opioid crisis has resulted in increased incidence of HCV as well as outbreaks of HIV among people who inject drugs (PWID). PWID may not access healthcare services because of stigma, abstinence requirements, and lack of available providers. This presentation will describe recent and ongoing work evaluating the effectiveness, cost-effectiveness, and implementation of different healthcare models designed to bring HCV/HIV testing and HCV care to PWID in a variety of settings including methadone maintenance programs, syringe service programs, and clinical settings.