Abstract:
BACKGROUND:The number of people on antiretroviral therapy (ART) requiring treatment monitoring in low-resource settings is rapidly increasing. Point-of-care (POC) testing for ART monitoring might alleviate burden on centralised laboratories and improve clinical outcomes, but its cost-effectiveness is unknown. METHODS:We used cost and effectiveness data from the STREAM trial in South Africa (February, 2017-October, 2018), which evaluated POC testing for viral load, CD4 count, and creatinine, with task shifting from professional to lower-cadre registered nurses compared with laboratory-based testing without task shifting (standard of care). We parameterised an agent-based network model, EMOD-HIV, to project the impact of implementing this intervention in South Africa over 20 years, simulating approximately 175 000 individuals per run. We assumed POC monitoring increased viral suppression by 9 percentage points, enrolment into community-based ART delivery by 25 percentage points, and switching to second-line ART by 1 percentage point compared with standard of care, as reported in the STREAM trial. We evaluated POC implementation in varying clinic sizes (10-50 patient initiating ART per month). We calculated incremental cost-effectiveness ratios (ICERs) and report the mean and 90% model variability of 250 runs, using a cost-effectiveness threshold of US$500 per disability-adjusted life-year (DALY) averted for our main analysis. FINDINGS:POC testing at 70% coverage of patients on ART was projected to reduce HIV infections by 4·5% (90% model variability 1·6 to 7·6) and HIV-related deaths by 3·9% (2·0 to 6·0). In clinics with 30 ART initiations per month, the intervention had an ICER of $197 (90% model variability -27 to 863) per DALY averted; results remained cost-effective when varying background viral suppression, ART dropout, intervention effectiveness, and reduction in HIV transmissibility. At higher clinic volumes (≥40 ART initiations per month), POC testing was cost-saving and at lower clinic volumes (20 ART initiations per month) the ICER was $734 (93 to 2569). A scenario that assumed POC testing did not increase enrolment into community ART delivery produced ICERs that exceeded the cost-effectiveness threshold for all clinic volumes. INTERPRETATION:POC testing is a promising strategy to cost-effectively improve patient outcomes in moderately sized clinics in South Africa. Results are most sensitive to changes in intervention impact on enrolment into community-based ART delivery. FUNDING:National Institutes of Health.
journal_name
Lancet HIVjournal_title
The lancet. HIVauthors
Sharma M,Mudimu E,Simeon K,Bershteyn A,Dorward J,Violette LR,Akullian A,Abdool Karim SS,Celum C,Garrett N,Drain PKdoi
10.1016/S2352-3018(20)30279-4subject
Has Abstractpub_date
2020-12-18 00:00:00eissn
2405-4704issn
2352-3018pii
S2352-3018(20)30279-4pub_type
杂志文章相关文献
Lancet HIV文献大全abstract:BACKGROUND:BMS-663068 is an oral prodrug of BMS-626529, an attachment inhibitor that binds to HIV-1 gp120, blocking viral attachment to host CD4 cells. AI438011 is an ongoing trial investigating the efficacy, safety, and dose-response of BMS-663068 in treatment-experienced, HIV-1-infected patients. Herein we present th...
journal_title:The lancet. HIV
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2352-3018(15)00177-0
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:In patients with HIV, immune reconstitution after antiretroviral therapy (ART) is often incomplete. We assessed the probability of patients reaching a CD4/CD8 ratio of 1 or more after the start of ART and its association with the onset of non-AIDS-defining events and death. METHODS:We did an analysis of the...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(15)00006-5
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Isoniazid preventive therapy prevents active tuberculosis in people with HIV, but previous studies have found no evidence of benefit in people with HIV who had a negative tuberculin skin test, and a non-significant effect on mortality. We aimed to estimate the effect of isoniazid preventive therapy given wit...
journal_title:The lancet. HIV
pub_type: 杂志文章,meta分析
doi:10.1016/S2352-3018(20)30299-X
更新日期:2021-01-01 00:00:00
abstract::Despite considerable progress in paediatric HIV treatment and timely revision of global policies recommending the use of more effective and tolerable antiretroviral regimens, optimal antiretroviral formulations for infants, children, and adolescents remain limited. The Paediatric Antiretroviral Drug Optimization group...
journal_title:The lancet. HIV
pub_type: 杂志文章,评审
doi:10.1016/S2352-3018(19)30193-6
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Simplified regimens with reduced pill burden and fewer side-effects are desirable for people living with HIV. We investigated the efficacy and safety of switching to a single-tablet regimen of darunavir, cobicistat, emtricitabine, and tenofovir alafenamide versus continuing a regimen of boosted protease inhi...
journal_title:The lancet. HIV
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2352-3018(17)30179-0
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:The HIV epidemic in the USA is a collection of diverse local microepidemics. We aimed to identify optimal combination implementation strategies of evidence-based interventions to reach 90% reduction of incidence in 10 years, in six US cities that comprise 24·1% of people living with HIV in the USA. METHODS:...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(20)30033-3
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Standard approaches to estimation of losses in the HIV cascade of care are typically cross-sectional and do not include the population stages before linkage to clinical care. We used indiviual-level longitudinal cascade data, transition by transition, including population stages, both to identify the health-...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(16)30224-7
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:As access to antiretroviral therapy (ART) expands, increasing numbers of older patients will start treatment and need specialised long-term care. However, the effect of age in ART programmes in resource-constrained settings is poorly understood. The HIV epidemic is ageing rapidly and South Africa has one of ...
journal_title:The lancet. HIV
pub_type: 杂志文章,多中心研究
doi:10.1016/S2352-3018(15)00113-7
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Although antiretroviral regimens containing integrase inhibitors rapidly suppress HIV viral load in non-pregnant adults, few published data from randomised controlled trials have compared the safety and efficacy of any integrase inhibitor to efavirenz when initiated during pregnancy. We compared safety and e...
journal_title:The lancet. HIV
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2352-3018(20)30038-2
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Incarceration provides an opportunity for engagement in HIV care but is associated with poor HIV treatment outcomes after release. We aimed to assess post-release linkage to HIV care (LTC) and the effect of transitional case management services. METHODS:To create a retrospective cohort of all adults with HI...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(17)30209-6
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:As HIV incidence and mortality continue to increase in eastern Europe and central Asia, particularly among people who inject drugs (PWID), it is crucial to effectively scale-up opioid agonist therapy (OAT), such as methadone or buprenorphine maintenance therapy, to optimise HIV outcomes. With low OAT coverag...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(19)30373-X
更新日期:2020-02-01 00:00:00
abstract::Progress in the development and introduction of paediatric formulations for key infectious diseases is poor in low-income and middle-income countries (LMICs). Although major steps have been made in the scale-up of antiretroviral medicines in LMICs, the development and deployment of formulations for infants and childre...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(18)30005-5
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:In high HIV burden settings, maximising the coverage of prevention strategies is crucial to achieving epidemic control. However, little is known about the reach and effect of these strategies in some communities. METHODS:We did a cross-sectional community survey in the adjacent Greater Edendale and Vulindle...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(18)30104-8
更新日期:2018-08-01 00:00:00
abstract::South Africa intends to include dolutegravir in its first-line antiretroviral therapy (ART) regimen because of cost savings, the drug's high barrier to resistance, and efficacy. However, recent data from Botswana suggest potential teratogenicity of dolutegravir. WHO recommends that non-pregnant women of childbearing a...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(18)30249-2
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Switching from therapy based on a boosted protease inhibitor to bictegravir, emtricitabine, and tenofovir alafenamide could avoid drug interactions and unwanted side-effects in virologically suppressed adults with HIV-1 infection, while maintaining a high barrier to resistance and providing a simplified once...
journal_title:The lancet. HIV
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2352-3018(18)30091-2
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Tuberculosis, which is often undiagnosed, is the major cause of death among HIV-positive people. We aimed to test whether the use of a clinical algorithm enabling the initiation of empirical tuberculosis treatment by nurses in primary health-care clinics would reduce mortality compared with standard of care ...
journal_title:The lancet. HIV
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2352-3018(19)30266-8
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:As pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine for the prevention of HIV infection is rolled out internationally, strategies to maintain effectiveness and to minimise adverse effects merit consideration. In this study, we aimed to assess reductions in renal function a...
journal_title:The lancet. HIV
pub_type: 临床试验,杂志文章
doi:10.1016/S2352-3018(16)30153-9
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:HIV evolves rapidly and therefore infections with similar genetic sequences are likely linked by recent transmission events. Clusters of related infections can represent subpopulations with high rates of transmission. We describe the implementation of an automated near real-time system to monitor and charact...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(16)00046-1
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND:Cabotegravir (GSK1265744) is an HIV-1 integrase strand transfer inhibitor with potent antiviral activity and a long half-life when administered by injection that prevented simian-HIV infection upon repeat intrarectal challenge in male macaques. We aimed to assess the safety, tolerability, and pharmacokinetic...
journal_title:The lancet. HIV
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2352-3018(17)30068-1
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:An intravaginal ring that releases the tenofovir prodrug, tenofovir disoproxil fumarate, provided 100% protection in macaques against simian HIV and was safe in a 14-day clinical trial in sexually abstinent women. We aimed to assess the safety and pharmacokinetics of this intravaginal ring over 90 days in se...
journal_title:The lancet. HIV
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2352-3018(19)30145-6
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:All recent treatment guidelines recommend integrase strand transfer inhibitors (INSTIs) as components of initial HIV therapy. Bictegravir, a novel, once-daily, unboosted INSTI, showed potent activity in a 10 day monotherapy study and has a high in-vitro resistance barrier. On the basis of these results, we d...
journal_title:The lancet. HIV
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2352-3018(17)30016-4
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Novel strategies are needed to increase retention in and uptake of prevention of mother-to-child HIV transmission (PMTCT) services in sub-Saharan Africa. We aimed to determine whether small, increasing cash payments, which were conditional on attendance at scheduled clinic visits and receipt of proposed serv...
journal_title:The lancet. HIV
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2352-3018(15)00247-7
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:Universal antiretroviral therapy (ART), as per the 2015 WHO recommendations, might reduce population HIV incidence. We investigated the effect of universal test and treat on HIV acquisition at population level in a high prevalence rural region of South Africa. METHODS:We did a phase 4, open-label, cluster r...
journal_title:The lancet. HIV
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2352-3018(17)30205-9
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:The South African national HIV plan recommends pre-exposure prophylaxis (PrEP) for transgender women, whose HIV prevalence estimates are as high as 25% in sub-Saharan Africa. The aim of this study was to explore PrEP awareness, uptake, and willingness, as well as associated barriers and facilitators, in orde...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(20)30119-3
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Measures of CD4 T-cell count and HIV-1 plasma viral load before antiretroviral therapy are proxies for virulence. Whether these proxies are changing over time has implications for prevention and treatment. The aim of this study was to investigate those trends. METHODS:Data were derived from the Concerted Ac...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(14)00002-2
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:Doravirine is a novel non-nucleoside reverse transcriptase inhibitor (NNRTI) with a pharmacokinetic profile supporting once-daily dosing, and potent in-vitro activity against the most common NNRTI-resistant HIV-1 variants. We compared doravirine with ritonavir-boosted darunavir, when both were given with two...
journal_title:The lancet. HIV
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2352-3018(18)30021-3
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Whether or not the association between some antiretrovirals used in HIV infection and chronic kidney disease is cumulative is a controversial topic, especially in patients with initially normal renal function. In this study, we aimed to investigate the association between duration of exposure to antiretrovir...
journal_title:The lancet. HIV
pub_type: 临床试验,杂志文章
doi:10.1016/S2352-3018(15)00211-8
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:With continued roll-out of antiretroviral therapy (ART) in resource-limited settings, evidence is emerging of increasing levels of transmitted drug-resistant HIV. We aimed to compare the effectiveness and cost-effectiveness of different potential public health responses to substantial levels of transmitted d...
journal_title:The lancet. HIV
pub_type: 杂志文章
doi:10.1016/S2352-3018(14)70021-9
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:HIV testing is the important entry point for HIV care and prevention service, but uptake of HIV testing and thus coverage of antiretroviral therapy are much lower in older children and adolescents than in adults. We investigated the effect of economic incentives provided to caregivers of children aged 8-17 y...
journal_title:The lancet. HIV
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2352-3018(17)30176-5
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Bictegravir co-formulated with emtricitabine and tenofovir alafenamide as a fixed-dose combination is recommended for treatment of HIV-1-infection and might be better tolerated than other integrase inhibitor-based single-tablet regimens, but long-term outcomes data are not available. We assessed the efficacy...
journal_title:The lancet. HIV
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/S2352-3018(19)30077-3
更新日期:2019-06-01 00:00:00