Abstract:
BACKGROUND:Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique. METHODS AND FINDINGS:We use a validated model of HIV testing, linkage, and treatment (CEPAC-International) to examine two strategies of immunological staging in Mozambique: (1) laboratory-based CD4 testing (LAB-CD4) and (2) point-of-care CD4 testing (POC-CD4). Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs). Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%), probability of correctly detecting antiretroviral therapy (ART) eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90%) or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%), and test cost (LAB-CD4, US$10; POC-CD4, US$24). In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570) to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%-61.0%), increasing to 65.0% (95% CI, 64.9%-65.1%) with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6-9.6 y) and US$2,440 (95% CI, US$2,440-US$2,450) and increase with POC-CD4 to 10.3 y (95% CI, 10.3-10.3 y) and US$2,800 (95% CI, US$2,790-US$2,800); the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS) (95% CI, US$480-US$520/YLS). POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity/specificity and higher cost than published values. In other resource-limited settings with fewer opportunities to access care, POC-CD4 has a greater impact on clinical outcomes and remains cost-effective compared to LAB-CD4. Limitations of the analysis include the uncertainty around input parameters, which is examined in sensitivity analyses. The potential added benefits due to decreased transmission are excluded; their inclusion would likely further increase the value of POC-CD4 compared to LAB-CD4. CONCLUSIONS:POC-CD4 at the time of HIV diagnosis could improve survival and be cost-effective compared to LAB-CD4 in Mozambique, if it improves linkage to care. POC-CD4 could have the greatest impact on mortality in settings where resources for HIV testing and linkage are most limited. Please see later in the article for the Editors' Summary.
journal_name
PLoS Medjournal_title
PLoS medicineauthors
Hyle EP,Jani IV,Lehe J,Su AE,Wood R,Quevedo J,Losina E,Bassett IV,Pei PP,Paltiel AD,Resch S,Freedberg KA,Peter T,Walensky RPdoi
10.1371/journal.pmed.1001725subject
Has Abstractpub_date
2014-09-16 00:00:00pages
e1001725issue
9eissn
1549-1277issn
1549-1676pii
PMEDICINE-D-14-01453journal_volume
11pub_type
杂志文章相关文献
PLOS MEDICINE文献大全abstract:BACKGROUND:Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001925
更新日期:2015-12-22 00:00:00
abstract:BACKGROUND:Identifying stage II patients with colorectal cancer (CRC) at higher risk of progression is a clinical priority in order to optimize the advantages of adjuvant chemotherapy while avoiding unnecessary toxicity. Recently, the intensity and the quality of the host immune response in the tumor microenvironment h...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003292
更新日期:2020-09-24 00:00:00
abstract::Alexander Tsai and colleagues highlight the complex relationship between poverty and HIV stigma in sub-Saharan Africa, and discuss possible ways to break the cycle. Please see later in the article for the Editors' Summary. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001557
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Malaria and hypertension are major causes of maternal mortality in tropical countries, especially during first pregnancies, but evidence for a relationship between these syndromes is contradictory. METHODS AND FINDINGS:In a cross-sectional survey of Tanzanian parturients, the rate of hypertension was simila...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030446
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Resistance of malaria parasites to chloroquine (CQ) and sulphadoxine-pyrimethamine (SP) is increasing in prevalence in Africa. Combination therapy can both improve treatment and provide important public health benefits if it curbs the spread of parasites harbouring resistance genes. Thus, drug combinations m...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.0020092
更新日期:2005-04-01 00:00:00
abstract:BACKGROUND:Spurred by the creation of potential modified risk tobacco products, the US Food and Drug Administration (FDA) commissioned the Institute of Medicine (IOM) to assess the science base for tobacco "harm reduction," leading to the 2001 IOM report Clearing the Smoke. The objective of this study was to determine ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001450
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Immunohistochemical markers are often used to classify breast cancer into subtypes that are biologically distinct and behave differently. The aim of this study was to estimate mortality for patients with the major subtypes of breast cancer as classified using five immunohistochemical markers, to investigate ...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.1000279
更新日期:2010-05-25 00:00:00
abstract::In an Editorial, Guest Editors Nicola Low and Nathalie Broutet discuss the Collection on sexually transmitted infections in the context of research priorities in the field. ...
journal_title:PLoS medicine
pub_type: 社论
doi:10.1371/journal.pmed.1002481
更新日期:2017-12-27 00:00:00
abstract:BACKGROUND:Counties are the smallest unit for which mortality data are routinely available, allowing consistent and comparable long-term analysis of trends in health disparities. Average life expectancy has steadily increased in the United States but there is limited information on long-term mortality trends in the US ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050066
更新日期:2008-04-22 00:00:00
abstract::In a Perspective, Hilary Seligman and Sanjay Basu discuss future scenarios of food assistance programs to improve population health in a changing political environment. ...
journal_title:PLoS medicine
pub_type: 评论,杂志文章
doi:10.1371/journal.pmed.1002662
更新日期:2018-10-02 00:00:00
abstract:BACKGROUND:Exposure to a nutritionally deficient environment during fetal life and early infancy may adversely alter the ontogeny of the immune system and affect an infant's ability to mount an optimal immune response to vaccination. We examined the effects of maternal nutritional supplementation during pregnancy on in...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1002854
更新日期:2019-08-06 00:00:00
abstract:BACKGROUND:Intravenous morphine (IVM) is the most common strong analgesic used in trauma, but is associated with a clear time limitation related to the need to obtain an access route. The intranasal (IN) route provides easy administration with a fast peak action time due to high vascularization and the absence of first...
journal_title:PLoS medicine
pub_type: 杂志文章,多中心研究
doi:10.1371/journal.pmed.1002849
更新日期:2019-07-16 00:00:00
abstract:BACKGROUND:The cesarean section (CS) rate has risen globally during the last two decades. Effective and feasible strategies are needed to reduce it. The aim of this study was to assess the CS rate change after a two-stage intervention package that was designed to reduce the overall CS rate in Guangzhou, China. METHODS...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002846
更新日期:2019-07-08 00:00:00
abstract:BACKGROUND:The anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody trastuzumab improves outcomes in patients with node-positive HER2+ early breast cancer. Given trastuzumab's high cost, we aimed to estimate its cost-effectiveness by heterogeneity in age and estrogen receptor (ER) and progesterone r...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002067
更新日期:2016-08-09 00:00:00
abstract:BACKGROUND:In recent decades, increased attention has been focused on the impact of disabilities and medicinal drug use on road safety. The aim of our study was to investigate the association between prescription medicines and the risk of road traffic crashes, and estimate the attributable fraction. METHODS AND FINDIN...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000366
更新日期:2010-11-16 00:00:00
abstract:BACKGROUND:The US Food and Drug Administration Amendments Act requires results from clinical trials of Food and Drug Administration-approved drugs to be posted at ClinicalTrials.gov within 1 y after trial completion. We compared the timing and completeness of results of drug trials posted at ClinicalTrials.gov and publ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001566
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Randomized clinical trials of oral antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention have widely divergent efficacy estimates, ranging from 0% to 75%. These discrepancies are likely due to differences in adherence. To our knowledge, no studies to date have examined the impact of improving adh...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001511
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Effective implementation strategies are needed to increase engagement in HIV services in hyperendemic settings. We conducted a pragmatic cluster-randomized trial in a high-risk, highly mobile fishing community (HIV prevalence: approximately 38%) in Rakai, Uganda, to assess the impact of a community health wo...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003475
更新日期:2021-01-06 00:00:00
abstract::How do we spot the next sexually transmitted infection? Kyle Bernstein and colleagues look for lessons from past discovery. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002474
更新日期:2017-12-27 00:00:00
abstract:BACKGROUND:Only about half the studies that have collected information on the relevance of women's height and body mass index to their risk of developing ovarian cancer have published their results, and findings are inconsistent. Here, we bring together the worldwide evidence, published and unpublished, and describe th...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.1001200
更新日期:2012-01-01 00:00:00
abstract::Thomas Platts-Mills and Matthew Perzanowski provide their expert Perspective on a translational study from Custovic and colleagues that identifies pairings of IgE that show value in estimating risk of concurrent asthma. ...
journal_title:PLoS medicine
pub_type: 评论,杂志文章
doi:10.1371/journal.pmed.1002696
更新日期:2018-11-20 00:00:00
abstract:BACKGROUND:Obesity is associated with low-grade chronic inflammation, and serum markers of inflammation are independent risk factors for cardiovascular disease (CVD). However, the molecular and cellular mechanisms that link obesity to chronic inflammation and CVD are poorly understood. METHODS AND FINDINGS:Acute-phase...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030287
更新日期:2006-06-01 00:00:00
abstract::[This corrects the article DOI: 10.1371/journal.pmed.1002781.]. ...
journal_title:PLoS medicine
pub_type: 已发布勘误
doi:10.1371/journal.pmed.1002880
更新日期:2019-07-18 00:00:00
abstract::In this Perspective on the clinical trial by Rita Alloway and colleagues, Simon Ball explains the benefits to healthcare systems and individual patients of the bioequivalence established between generic and brand-name formulations of an immunosuppressive drug in transplant recipients. ...
journal_title:PLoS medicine
pub_type: 评论,杂志文章
doi:10.1371/journal.pmed.1002429
更新日期:2017-11-14 00:00:00
abstract:BACKGROUND:Violence against women by intimate partners remains unacceptably common worldwide. The evidence base for the assumed psychological impacts of intimate partner violence (IPV) is derived primarily from studies conducted in high-income countries. A recently published systematic review identified 13 studies link...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001943
更新日期:2016-01-19 00:00:00
abstract:BACKGROUND:Breast cancer is a leading malignancy affecting the female population worldwide. Most morbidity is caused by metastases that remain incurable to date. TGF-β1 has been identified as a key driving force behind metastatic breast cancer, with promising therapeutic implications. METHODS AND FINDINGS:Employing im...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001871
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Previous estimates of mortality in Iraq attributable to the 2003 invasion have been heterogeneous and controversial, and none were produced after 2006. The purpose of this research was to estimate direct and indirect deaths attributable to the war in Iraq between 2003 and 2011. METHODS AND FINDINGS:We condu...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001533
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Evidence of the short-term effects of ambient air pollution on the risk of ischemic stroke in low- and middle-income countries is limited and inconsistent. We aimed to examine the associations between air pollution and daily hospital admissions for ischemic stroke in China. METHODS AND FINDINGS:We identifie...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002668
更新日期:2018-10-04 00:00:00
abstract:BACKGROUND:The proteases (secretases) that cleave amyloid-beta (Abeta) peptide from the amyloid precursor protein (APP) have been the focus of considerable investigation in the development of treatments for Alzheimer disease. The prediction has been that reducing Abeta production in the brain, even after the onset of c...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0020355
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:Global warming is predicted to indirectly result in more undernutrition by threatening crop production. Whether temperature rise could affect undernutrition directly is unknown. We aim to quantify the relationship between short-term heat exposure and risk of hospitalization due to undernutrition in Brazil. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002950
更新日期:2019-10-29 00:00:00