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90-90-90 HIV initiative would yield 'extraordinary returns' in South Africa

American College of Physicians

1. Investment in 90-90-90 initiative would yield "extraordinary returns" in the fight against HIV in South Africa

Abstract: http://www. annals. org/ article. aspx?doi= 10. 7326/ M16-0799

30-May-2016 - An expensive and ambitious initiative to end the AIDS epidemic in South Africa by 2020 would be both extraordinarily effective and cost-effective, according to a modeling study published in Annals of Internal Medicine . The Joint Nations Program on HIV/AIDS, or UNAIDS, 90-90-90 initiative calls for 90 percent of people living with HIV in South Africa to know their status, 90 percent of those diagnosed with HIV to access antiretroviral therapy (ART), and 90 percent of people on ART to achieve viral suppression by 2020. Achieving these targets would produce virologic suppression in 73 percent of patients worldwide, a marked increase over current estimates of 29 percent.

While the moral and public health imperative for 90-90-90 has been established, much less is known about how reaching its treatment targets will translate into broader, downstream health and social outcomes. With a price tag of about $54 billion over the next 10 years -- an increase of approximately $16 billion over current HIV detection and treatment efforts -- it is important for global partners to understand the return on investment.

Researchers used the Cost-Effectiveness of Preventing AIDS Complications-International (CEPAC-I) microsimulation model and South African data to compare current treatment strategies with those of the 90-90-90 initiative. Over both 5- and 10-year horizons, the researchers projected cumulative HIV transmissions, deaths, years of life saved, numbers of children becoming orphans, lifetime costs, and incremental cost-effectiveness. They found that by every measure, achieving the UNAIDS targets would have a transformative impact: averting millions of new HIV infections; saving millions of lives and tens of millions of years of life; preventing millions of children from becoming orphans; and thereby curtailing the global pandemic.

The researchers note that achieving 90-90-90 targets will not be easy or inexpensive. However, if the 90-90-90 targets for HIV diagnosis, treatment, and virologic suppression can be achieved in South Africa, "enormous population and clinical benefits will follow."

Note: For an embargoed PDF, please contact Cara Graeff. For an interview with the lead author, Dr. Rochelle Walensky at Massachusetts General Hospital, please contact Noah Brown at or 617-643-3907. To interview Dr. David Paltiel at Yale, please contact Michael Greenwood at

2. Public reporting of hospital mortality rates for common conditions did not improve patient outcomes

Abstract: http://www. annals. org/ article. aspx?doi= 10. 7326/ M15-1462

Public reporting of hospital mortality rates to the Hospital Compare Program was not associated with an improvement in 30-day mortality rates. The findings are published in Annals of Internal Medicine .

The goal of the Hospital Compare Program, led by the Centers for Medicare and Medicaid Services (CMS), is to increase transparency for consumers and encourage hospitals to improve performance and achieve better clinical patient outcomes. Although public reporting is seen as a powerful quality improvement tool, there has been surprisingly little evidence to support its efficacy, according to authors. Given the resources spent on Hospital Compare and its importance to ongoing health reform efforts, understanding its effect on mortality rates for reported conditions is critically important.

Researchers studied hospitals that were reporting data on processes of care for at least one condition in the Hospital Compare program, representing roughly 85 percent of U.S. acute care hospitals. Using inpatient files of hospitalizations for fee-for-service Medicare beneficiaries, the researchers calculated the average change in mortality for patients with acute myocardial infarction, congestive heart failure, or pneumonia between the program's initiation in January 2005 through November 2012. They found that none of the individual conditions saw better outcomes during this period. The researchers suggest that it may take longer for benefits of public reporting to accrue and further evaluation will be needed.

Note: For an embargoed PDF, please contact Cara Graeff. For an interview with the lead author, Dr. Karen Joynt, please contact Haley Bridger at or 617-525-6383.

3. NIH Pathways to Prevention Workshop yields 8 recommendations for advancing NIOSH Total Worker Health program

Abstract: http://www. annals. org/ article. aspx?doi= 10. 7326/ M16-0740

Abstract (Review): http://www. annals. org/ article. aspx?doi= 10. 7326/ M16-0626

Editorial: http://www. annals. org/ article. aspx?doi= 10. 7326/ M16-0904

Editorial: http://www. annals. org/ article. aspx?doi= 10. 7326/ M16-0965

A small body of evidence suggests that integrated Total Worker Health interventions may help employees improve some health behaviors, but more research is necessary to determine whether these interventions decrease injuries or improve overall quality of life. The evidence review, along with expert presentations and public comment, helped to inform a report identifying research gaps and future research priorities for advancing the science of integrated interventions to improve the total health of workers. The evidence review and report summarizing 8 specific research recommendations are published in Annals of Internal Medicine , along with a response from the National Institute of Occupational Safety and Health (NIOSH).

More than 151 million people work in the United States. Work provides not only income, but ideally, social connection, meaningful activity, and benefits to pay for healthcare. However, workplace factors may also contribute to adverse health outcomes traditionally considered to be unrelated to work, such as cardiovascular disease and depression. NIOSH, a part of the Centers for Disease Control and Prevention (CDC), began focusing on integrated approaches to worker health and safety in 2011 by creating the Total Worker Health program. Total Worker health is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. The goal of the program is to advance worker well-being by integrating injury and illness prevention efforts with work-related safety and health hazard efforts.

Researchers for the Agency for Healthcare Research and Quality (AHRQ) reviewed published evidence on Total Worker Health Interventions to evaluate their benefits and harms. While evidence was slim in most areas of interest, the researchers did find limited evidence that integrated Total Worker Health interventions can improve health behaviors, such as reducing tobacco use and sedentary behavior and improving diet. This review helped to inform recommendations that NIOSH has committed to implementing as soon as possible with the goal of setting a research agenda and filling evidence gaps.

Note: For an embargoed PDF, please contact Cara Graeff. For an interview with Dr. Susan Curry regarding the recommendations for Total Worker Health initiatives, please contact Dan McMillan at or 319-335-6835.

Also new in this issue:

Progress in the Fight Against Multidrug Resistant Bacteria? A Systematic Review of U.S. Food and Drug Administration-Approved Antibiotics, 2010-2015

Dalia Deak, MPH; Kevin Outterson, LLM, JD; John H. Powers, MD; and Aaron S. Kesselheim, MD, JD, MPH

Medicine and Public Issues

Abstract: http://www. annals. org/ article. aspx?doi= 10. 7326/ M16-0291


Media Contact
Cara Graeff
http://www. acponline. org 


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