Cost-eff ectiveness of community-based strategies to strengthen the continuum of HIV care in rural South Africa: a health economic modelling analysis

被引:58
作者
Smith, Jennifer A. [1 ]
Sharma, Monisha [2 ]
Levin, Carol [3 ]
Baeten, Jared M. [2 ,3 ,4 ]
van Rooyen, Heidi [5 ]
Celum, Connie [2 ,3 ,4 ]
Hallett, Timothy B. [1 ]
Barnabas, Ruanne V. [2 ,3 ,4 ,6 ]
机构
[1] Univ London Imperial Coll Sci Technol & Med, Dept Infect Dis Epidemiol, London, England
[2] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA
[3] Univ Washington, Dept Global Hlth, Seattle, WA 98195 USA
[4] Univ Washington, Dept Med, Seattle, WA USA
[5] Human Sci Res Council, HIV AIDS STIs & TB, Sweetwaters, Kwazulu Natal, South Africa
[6] Fred Hutchinson Canc Res Ctr, Vaccine & Infect Dis Div, Seattle, WA 98104 USA
来源
LANCET HIV | 2015年 / 2卷 / 04期
基金
比尔及梅琳达.盖茨基金会; 英国惠康基金; 美国国家卫生研究院;
关键词
SUB-SAHARAN AFRICA; ANTIRETROVIRAL THERAPY; TESTING STRATEGIES; PREVENTION; INITIATION; COVERAGE; IMPACT; UGANDA; TRIAL; TRANSMISSION;
D O I
10.1016/S2352-3018(15)00016-8
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background Home HIV counselling and testing (HTC) achieves high coverage of testing and linkage to care compared with existing facility-based approaches, particularly among asymptomatic individuals. In a modelling analysis we aimed to assess the effect on population-level health and cost-effectiveness of a community-based package of home HTC in KwaZulu-Natal, South Africa. Methods We parameterised an individual-based model with data from home HTC and linkage field studies that achieved high coverage (91%) and linkage to antiretroviral therapy (80%) in rural KwaZulu-Natal, South Africa. Costs were derived from a linked microcosting study. The model simulated 10 000 individuals over 10 years and incremental cost-effectiveness ratios were calculated for the intervention relative to the existing status quo of facility-based testing, with costs discounted at 3% annually. Findings The model predicted implementation of home HTC in addition to current practice to decrease HIV-associated morbidity by 10-22% and HIV infections by 9-48% with increasing CD4 cell count thresholds for antiretroviral therapy initiation. Incremental programme costs were US$2.7 million to $4.4 million higher in the intervention scenarios than at baseline, and costs increased with higher CD4 cell count thresholds for antiretroviral therapy initiation; antiretroviral therapy accounted for 48-87% of total costs. Incremental cost-effectiveness ratios per disability-adjusted life-year averted were $1340 at an antiretroviral therapy threshold of CD4 count lower than 200 cells per mu L, $1090 at lower than 350 cells per mu L, $1150 at lower than 500 cells per mu L, and $1360 at universal access to antiretroviral therapy. Interpretation Community-based HTC with enhanced linkage to care can result in increased HIV testing coverage and treatment uptake, decreasing the population burden of HIV-associated morbidity and mortality. The incremental cost-eff ectiveness ratios are less than 20% of South Africa's gross domestic product per person, and are therefore classed as very cost effective. Home HTC can be a viable means to achieve UNAIDS' ambitious new targets for HIV treatment coverage. Copyright (C) Smith et al. Open Access article distributed under the terms of CC BY.
引用
收藏
页码:E159 / E168
页数:10
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