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HIV testing and counselling couples together for affordable HIV prevention in Africa.

Abstract：

BACKGROUND:The impact and cost-effectiveness of couples' voluntary HIV counselling and testing (CVCT) has not been quantified in real-world settings. We quantify cost-per-HIV-infection averted by CVCT in Zambia from the donor's perspective. METHODS:From 2010 to 2016, CVCT was established in 73 Zambian government clinics. The cost-per-HIV-infection averted (CHIA) of CVCT was calculated using observed expenditures and effectiveness over longitudinal follow-up. These observed measures parameterized hypothetical 5-year nationwide implementations of: 'CVCT'; 'treatment-as-prevention (TasP) for discordant couples' identified by CVCT; and 'population TasP' for all HIV+ cohabiting persons identified by individual testing. RESULTS:In all, 207 428 couples were tested (US $52/couple). Among discordant couples in which HIV+ partners self-reported antiretroviral therapy (ART), HIV incidence was 8.5/100 person-years before and 1.8/100 person-years after CVCT (79% reduction). Corresponding reductions for non-ART-using discordant and concordant negative couples were 63% and 47%, respectively. CVCT averted an estimated 58% of new infections at US $659 CHIA. In nationwide implementation models, CVCT would prevent 17 times the number of infections vs 'TasP for discordant couples' at 86% of the cost, and nine times the infections vs 'population TasP' at 28% of the cost. CONCLUSIONS:CVCT is a cost-effective, feasible prevention strategy in Zambia. We demonstrate the novel, added effectiveness of providing CVCT to ART users, for whom ART use alone only partially mitigated transmission risk. Our results indicate a major policy shift (supporting development of CVCT indicators, budgets and targets) and have clinical implications (suggesting promotion of CVCT in ART clinics as a high-impact prevention strategy).

journal_name

Int J Epidemiol

journal_title

International journal of epidemiology

authors

Wall KM,Inambao M,Kilembe W,Karita E,Vwalika B,Mulenga J,Parker R,Sharkey T,Sonti D,Tichacek A,Hunter E,Yohnka R,Abdallah JF,Thior I,Pulerwitz J,Allen S

doi

10.1093/ije/dyy203

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

217-227

issue

eissn

0300-5771

issn

1464-3685

pii

5144579

journal_volume

pub_type

杂志文章,多中心研究

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HIV testing and counselling couples together for affordable HIV prevention in Africa.