Cost analysis of a frequent user's program in New York City in the prevention of HIV and STDs

Background: Programs providing rental assistance and other support to high risk adults with multiple jail stays and homeless shelter experiences can help mitigate exposure to HIV cost-effectively. Studies have shown that over the course of their illness, roughly 50% of the HIV population can be classified as unstably housed. As half of the HIV population migrates through jail or homeless shelters, they face increased exposure to HIV risk behaviors, are more likely to receive suboptimal antiretroviral therapy, have poorer access to regular care and are less likely to adhere to therapy. Methods: We perform a cost-benefit and cost-effectiveness study of the Frequent Users Services Enhancement (FUSE) program, taking into account the averted costs of HIV, and other STDs. We compare the incremental costs, health care resource utilization rates, cost-utility and cost-benefit ratios for our intervention group. Results: Prior to the intervention, participants engaged in sexual behavior making them at risk to HIV infection. Approximately 13% had 3 or more partners over a six month interval and approximately 42% reporting not using a condom during sex. We use the Bernoullian model of HIV transmission to translate changes in risky sexual behavior into estimated cases of HIV infections averted. Averted infections are translated to net savings to society from averted HIV/AIDS associated costs. Conclusions: Preliminary results suggest that a housing program can avert significant health care costs and reduce the risk of HIV infection among the unstably housed. Our results will provide information on real costs and utilization rates of housing programs.