Cost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa: health economic and modelling analysis.

Abstract:

INTRODUCTION:As prevalence of undiagnosed HIV declines, it is unclear whether testing programmes will be cost-effective. To guide their HIV testing programmes, countries require appropriate metrics that can be measured. The cost-per-diagnosis is potentially a useful metric. METHODS:We simulated a series of setting-scenarios for adult HIV epidemics and ART programmes typical of settings in southern Africa using an individual-based model and projected forward from 2018 under two policies: (i) a minimum package of "core" testing (i.e. testing in pregnant women, for diagnosis of symptoms, in sex workers, and in men coming forward for circumcision) is conducted, and (ii) core-testing as above plus additional testing beyond this ("additional-testing"), for which we specify different rates of testing and various degrees to which those with HIV are more likely to test than those without HIV. We also considered a plausible range of unit test costs. The aim was to assess the relationship between cost-per-diagnosis and the incremental cost-effectiveness ratio (ICER) of the additional-testing policy. The discount rate used in the base case was 3% per annum (costs in 2018 U.S. dollars). RESULTS:There was a strong graded relationship between the cost-per-diagnosis and the ICER. Overall, the ICER was below $500 per-DALY-averted (the cost-effectiveness threshold used in primary analysis) so long as the cost-per-diagnosis was below $315. This threshold cost-per-diagnosis was similar according to epidemic and programmatic features including the prevalence of undiagnosed HIV, the HIV incidence and a measure of HIV programme quality (the proportion of HIV diagnosed people having a viral load <1000 copies/mL). However, restricting to women, additional-testing did not appear cost-effective even at a cost-per-diagnosis of below $50, while restricting to men additional-testing was cost-effective up to a cost-per-diagnosis of $585. The threshold cost per diagnosis for testing in men to be cost-effective fell to $256 when the cost-effectiveness threshold was $300 instead of $500, and to $81 when considering a discount rate of 10% per annum. CONCLUSIONS:For testing programmes in low-income settings in southern African there is an extremely strong relationship between the cost-per-diagnosis and the cost-per-DALY averted, indicating that the cost-per-diagnosis can be used to monitor the cost-effectiveness of testing programmes.

journal_name

J Int AIDS Soc

authors

Phillips AN,Cambiano V,Nakagawa F,Bansi-Matharu L,Wilson D,Jani I,Apollo T,Sculpher M,Hallett T,Kerr C,van Oosterhout JJ,Eaton JW,Estill J,Williams B,Doi N,Cowan F,Keiser O,Ford D,Hatzold K,Barnabas R,Ayles H,Me

doi

10.1002/jia2.25325

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

e25325

issue

7

issn

1758-2652

journal_volume

22

pub_type

杂志文章
  • How does living with HIV impact on women's mental health? Voices from a global survey.

    abstract:INTRODUCTION:Women living with HIV experience a disproportionate burden of mental health issues. To date, global guidelines contain insufficient guidance on mental health support, particularly regarding perinatal care. The aim of this article is to describe the extent and impact of mental health issues as experienced b...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.7448/IAS.18.6.20289

    authors: Orza L,Bewley S,Logie CH,Crone ET,Moroz S,Strachan S,Vazquez M,Welbourn A

    更新日期:2015-12-01 00:00:00

  • Viral escape in the CNS with multidrug-resistant HIV-1.

    abstract:INTRODUCTION:HIV-1 viral escape in the cerebrospinal fluid (CSF) despite viral suppression in plasma is rare [1,2]. We describe the case of a 50-year-old HIV-1 infected patient who was diagnosed with HIV-1 in 1995. Antiretroviral therapy (ART) was started in 1998 with a CD4 T cell count of 71 cells/ìL and HIV-viremia o...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.7448/IAS.17.4.19745

    authors: Béguelin C,Vázquez M,Bertschi M,Yerly S,de Jong D,Rauch A,Cusini A

    更新日期:2014-11-02 00:00:00

  • Prisoners co-infected with tuberculosis and HIV: a systematic review.

    abstract:INTRODUCTION:Almost from the beginning of the HIV epidemic in 1981, an association with tuberculosis (TB) was recognized. This association between HIV and TB co-infection has been particularly evident amongst prisoners. However, despite this, few studies of TB in prisons have stratified results by HIV status. Given the...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,评审

    doi:10.7448/IAS.19.1.20960

    authors: Edge CL,King EJ,Dolan K,McKee M

    更新日期:2016-11-15 00:00:00

  • Men who have sex with men more often chose daily than event-driven use of pre-exposure prophylaxis: baseline analysis of a demonstration study in Amsterdam.

    abstract:INTRODUCTION:The Amsterdam PrEP project is a prospective, open-label demonstration study at a large sexually transmitted infection (STI) clinic. We examined the uptake of PrEP; the baseline characteristics of men who have sex with men (MSM) and transgender persons initiating PrEP; their choices of daily versus event-dr...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.1002/jia2.25105

    authors: Hoornenborg E,Achterbergh RC,van der Loeff MFS,Davidovich U,van der Helm JJ,Hogewoning A,van Duijnhoven YT,Sonder GJ,de Vries HJ,Prins M,Amsterdam PrEP Project team in the HIV Transmission Elimination AMsterdam Initiative.

    更新日期:2018-03-01 00:00:00

  • Integrating oral PrEP delivery among African women in a large HIV endpoint-driven clinical trial.

    abstract:INTRODUCTION:Global guidelines emphasize the ethical obligation of investigators to help participants in HIV-endpoint trials reduce HIV risk by offering an optimal HIV prevention package. Oral pre-exposure prophylaxis (PrEP) has increasingly become part of state-of-the-art HIV prevention. Here we describe the process o...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,随机对照试验

    doi:10.1002/jia2.25491

    authors: Beesham I,Welch JD,Heffron R,Pleaner M,Kidoguchi L,Palanee-Phillips T,Ahmed K,Baron D,Bukusi EA,Louw C,Mastro TD,Smit J,Batting JR,Malahleha M,Bailey VC,Beksinska M,Donnell D,Baeten JM,ECHO Trial Consortium.

    更新日期:2020-05-01 00:00:00

  • Perspectives of US women participating in a candidate PrEP study: adherence, acceptability and future use intentions.

    abstract:INTRODUCTION:Limited data exist on acceptability of candidate pre-exposure prophylaxis (PrEP) regimens among US women. We evaluated PrEP experiences, attitudes and future use intentions among sexually active women who completed the US-based HIV Prevention Trials Network 069/AIDS Clinical Trials Group 5305 study. METHO...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,随机对照试验

    doi:10.1002/jia2.25247

    authors: Amico KR,Ramirez C,Caplan MR,Montgomery BE,Stewart J,Hodder S,Swaminathan S,Wang J,Darden-Tabb NY,McCauley M,Mayer KH,Wilkin T,Landovitz RJ,Gulick R,Adimora AA,HPTN 069\/A5305 Study Team and HPTN Women at Risk Committee.

    更新日期:2019-03-01 00:00:00

  • Prevalence and factors associated with fertility desires/intentions among individuals in HIV-serodiscordant relationships: a systematic review of empirical studies.

    abstract:INTRODUCTION:Better knowledge about fertility desires/intentions among HIV-serodiscordant partners who face unique challenges when considering childbearing may be helpful in the development of targeted reproductive interventions. The aim of this systematic review was to synthesize the published literature regarding the...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,meta分析

    doi:10.1002/jia2.25241

    authors: Martins A,Alves S,Chaves C,Canavarro MC,Pereira M

    更新日期:2019-05-01 00:00:00

  • CNS safety at 48-week of switching to ATV/r plus 3TC or two nucleos(t)ides in HIV-suppressed patients on stable ART: the SALT neurocognitive sub-study.

    abstract:INTRODUCTION:Due to their low CNS penetrance, there are concerns about the capacity of non-conventional PI-based ART (monotherapy and dual therapies) to preserve neurocognitive performance (NP). METHODS:We evaluated the NP change of aviremic participants of the SALT clinical trial (1) switching therapy to dual therapy...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.7448/IAS.17.4.19656

    authors: Valero IP,Pasquau J,Rubio R,Ribero A,Santos J,Sanz J,Mariño A,Crespo M,Hernandez J,Iribarren JA,Gutierrez F,Terron A,Esteban H,Pérez-Molina JA

    更新日期:2014-11-02 00:00:00

  • Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence.

    abstract:INTRODUCTION:Qualitative research on antiretroviral therapy (ART) adherence interventions can provide a deeper understanding of intervention facilitators and barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking. ...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,评审

    doi:10.7448/IAS.19.1.21166

    authors: Ma Q,Tso LS,Rich ZC,Hall BJ,Beanland R,Li H,Lackey M,Hu F,Cai W,Doherty M,Tucker JD

    更新日期:2016-10-17 00:00:00

  • Agency as a mediator in the pathway from transactional sex to HIV among pregnant women in Swaziland: a multigroup path analysis.

    abstract:INTRODUCTION:Transactional sex is a structural driver of HIV for women and girls in sub-Saharan Africa. In transactional relationships, sexual and economic obligations intertwine and may have positive and negative effects on women's financial standing and social status. We conducted a clinic-based survey with pregnant ...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.7448/IAS.20.1.21554

    authors: Fielding-Miller R,Dunkle KL,Hadley C,Cooper HL,Windle M

    更新日期:2017-07-18 00:00:00

  • The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission.

    abstract:INTRODUCTION:Gonorrhoea and chlamydia cases have been rising among gay, bisexual and other men who have sex with men (MSM) over the last decade. The majority of cases are extragenital and occur at the oropharynx and anorectum. The aim of this narrative review was to review the risk factors and mode of transmission for ...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,评审

    doi:10.1002/jia2.25354

    authors: Chow EP,Fairley CK

    更新日期:2019-08-01 00:00:00

  • Placental Hofbauer cells assemble and sequester HIV-1 in tetraspanin-positive compartments that are accessible to broadly neutralizing antibodies.

    abstract:INTRODUCTION:Within monocyte-derived macrophages, HIV-1 accumulates in intracellular virus-containing compartments (VCCs) that are inaccessible to the external environment, which implicate these cells as latently infected HIV-1 reservoirs. During mother-to-child transmission of HIV-1, human placental macrophages (Hofba...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.7448/IAS.18.1.19385

    authors: Johnson EL,Chu H,Byrareddy SN,Spearman P,Chakraborty R

    更新日期:2015-01-22 00:00:00

  • Collateral benefits: how the practical application of Good Participatory Practice can strengthen HIV research in sub-Saharan Africa.

    abstract:INTRODUCTION:The Good Participatory Practice (GPP): Guidelines for Biomedical HIV Prevention Trials, second edition (2011) were developed to provide clinical trial sponsors and implementers with a formal stakeholder engagement framework. As one of the largest African research institutes, Wits Reproductive Health and HI...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.1002/jia2.25175

    authors: Baron D,Essien T,Pato S,Magongo M,Mbandazayo N,Scorgie F,Rees H,Delany-Moretlwe S

    更新日期:2018-10-01 00:00:00

  • Efficacy and safety in clinical practice of a rilpivirine, tenofovir and emtricitabine single-tablet regimen in virologically suppressed HIV-positive patients on stable antiretroviral therapy.

    abstract:INTRODUCTION:Switching to a rilpivirine, tenofovir and emtricitabine (RTE) single-tablet regimen (STR) has been evaluated in a limited number of virologically suppressed patients. The aim of this study was to describe clinical outcomes in HIV-positive patients switched from a suppressive antiretroviral regimen to RTE S...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.7448/IAS.18.1.20037

    authors: Gianotti N,Poli A,Nozza S,Spagnuolo V,Tambussi G,Bossolasco S,Cinque P,Maillard M,Cernuschi M,Galli L,Lazzarin A,Castagna A

    更新日期:2015-07-30 00:00:00

  • Atazanavir/ritonavir monotherapy as maintenance strategy in HIV-1 treated subjects with viral suppression: 96-week analysis results of the MODAT study.

    abstract:INTRODUCTION:The 48-week interim analysis of the MODAT study showed that confirmed virologic failure (CVF) was more frequent in patients simplifying to ATV/r monotherapy compared to maintaining ATV/r-based triple therapy. The DSMB recommended stopping study enrollment but continuing follow-up of enrolled patients. We p...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.7448/IAS.17.4.19806

    authors: Spagnuolo V,Galli L,Bigoloni A,Nozza S,Monforte Ad,Antinori A,Di Biagio A,Rusconi S,Guaraldi G,Di Giambenedetto S,Lazzarin A,Castagna A

    更新日期:2014-11-02 00:00:00

  • Characteristics of late presentation of HIV infection in MSM and heterosexual adults in Portugal 2011-2013.

    abstract:INTRODUCTION:It is estimated that over half of newly diagnosed HIV infections in Europe present late. An HIV positive individual presenting late to care represents a missed opportunity to benefit from treatment, increasing the risk of morbidity and mortality at an individual level, and onward disease transmission at po...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.7448/IAS.17.4.19690

    authors: Shivaji T,Diniz A,Cortes-Martins H

    更新日期:2014-11-02 00:00:00

  • The changing face of HIV vaccine research.

    abstract::While there has been remarkable progress in understanding the biology of HIV-1 and its recognition by the human immune system, we have not yet developed an efficacious HIV-1 vaccine. Vaccine challenges include the genetic diversity and mutability of HIV-1 which create a plethora of constantly changing antigens, the st...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,评审

    doi:10.7448/IAS.15.2.17407

    authors: Kwong PD,Mascola JR,Nabel GJ

    更新日期:2012-07-05 00:00:00

  • Trends and predictors of non-communicable disease multimorbidity among adults living with HIV and receiving antiretroviral therapy in Brazil.

    abstract:INTRODUCTION:People living with HIV (PLHIV) on antiretroviral therapy (ART) experience high rates of non-communicable diseases (NCDs). These co-morbidities often accumulate and older adults may suffer from multimorbidity. Multimorbidity has been associated with loss of quality of life, polypharmacy, and increased risk ...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.1002/jia2.25233

    authors: Castilho JL,Escuder MM,Veloso V,Gomes JO,Jayathilake K,Ribeiro S,Souza RA,Ikeda ML,de Alencastro PR,Tupinanbas U,Brites C,McGowan CC,Grangeiro A,Grinsztejn B

    更新日期:2019-01-01 00:00:00

  • Liver Fibrosis progression using Fibroscan in HIV/HCV coinfected patients with undetectable HIV viral load.

    abstract:INTRODUCTION:Several factors such as duration of infection, age, male gender, consumption of alcohol, HIV infection and low CD4 count have been associated with fibrosis progression rate. However, it is relatively scarce, the knowledge about the liver fibrosis progression rate in HIV-infected patients with undetectable ...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.7448/IAS.17.4.19636

    authors: Perez-Martinez L,Sanjoaquin I,Rivero M,Gil-Pérez D,Letona S,Olaiz CI,Arazo P,Blanco JR

    更新日期:2014-11-02 00:00:00

  • Index and targeted community-based testing to optimize HIV case finding and ART linkage among men in Zambia.

    abstract:INTRODUCTION:Current healthcare systems fail to provide adequate HIV services to men. In Zambia, 25% of adult men living with HIV were unaware of their HIV status in 2018, and 12% of those who were unaware of their HIV statu were not receiving antiretroviral therapy (ART) due to pervasive barriers to HIV testing servic...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.1002/jia2.25520

    authors: Mwango LK,Stafford KA,Blanco NC,Lavoie MC,Mujansi M,Nyirongo N,Tembo K,Sakala H,Chipukuma J,Phiri B,Nzangwa C,Mwandila S,Nkwemu KC,Saadani A,Mwila A,Herce ME,Claassen CW

    更新日期:2020-06-01 00:00:00

  • Neurocognitive impairment among HIV-positive individuals in Botswana: a pilot study.

    abstract:BACKGROUND:The primary objective of this study was to determine the prevalence of neurocognitive impairment among HIV-positive individuals in Botswana, using the International HIV Dementia Scale (IHDS). We also compared performance on the IHDS with performance on tests of verbal learning/memory and processing speed, an...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.1186/1758-2652-13-15

    authors: Lawler K,Mosepele M,Ratcliffe S,Seloilwe E,Steele K,Nthobatsang R,Steenhoff A

    更新日期:2010-04-20 00:00:00

  • Awareness and perceived fairness of Option B+ in Malawi: A population-level perspective

    abstract:INTRODUCTION:Policies for rationing antiretroviral therapy (ART) have been subject to on-going ethical debates. Introduced in Malawi in 2011, Option B+ prioritized HIV-positive pregnant women for lifelong ART regardless of the underlying state of their immune system, shifting the logic of allocation away from medical e...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.7448/IAS.20.1.21467

    authors: Yeatman S,Trinitapoli J

    更新日期:2017-03-08 00:00:00

  • HIV knowledge trends during an era of rapid antiretroviral therapy scale-up: an analysis of 33 sub-Saharan African countries.

    abstract:INTRODUCTION:Population-level improvements in knowledge about HIV may reduce the stigma attached to HIV and ensure maximal uptake of HIV prevention initiatives. The extent to which levels of HIV knowledge in the general population of sub-Saharan Africa have changed in the current era of antiretroviral therapy (ART) sca...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.1002/jia2.25169

    authors: Chan BT,Tsai AC

    更新日期:2018-07-01 00:00:00

  • Estimating the costs and cost-effectiveness of HIV self-testing among men who have sex with men, United States.

    abstract:INTRODUCTION:HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre-exposure prophylaxis. Internet distribution of HIV self-tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs and cost-effectiveness...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,随机对照试验

    doi:10.1002/jia2.25445

    authors: Shrestha RK,Chavez PR,Noble M,Sansom SL,Sullivan PS,Mermin JH,MacGowan RJ

    更新日期:2020-01-01 00:00:00

  • Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa.

    abstract:INTRODUCTION:We aimed to quantify and identify associated factors of linkage to HIV care following home-based HIV counselling and testing (HBHCT) in the ongoing ANRS 12249 treatment-as-prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa. METHODS:Individuals ≥16 years were offered HBHCT; tho...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,随机对照试验

    doi:10.7448/IAS.19.1.20913

    authors: Plazy M,Farouki KE,Iwuji C,Okesola N,Orne-Gliemann J,Larmarange J,Lert F,Newell ML,Dabis F,Dray-Spira R,Anrs 12249 Tasp Study Group.

    更新日期:2016-06-01 00:00:00

  • The effects of educational curricula and training on LGBT-specific health issues for healthcare students and professionals: a mixed-method systematic review.

    abstract:INTRODUCTION:Poor access of lesbian, gay, bisexual and transgender (LGBT) people to healthcare providers with clinical and cultural competency contributes to health inequalities between heterosexual/cisgender and LGBT people. This systematic review assesses the effect of educational curricula and training for healthcar...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,评审

    doi:10.7448/IAS.20.1.21624

    authors: Sekoni AO,Gale NK,Manga-Atangana B,Bhadhuri A,Jolly K

    更新日期:2017-07-19 00:00:00

  • The case for viral load testing in adolescents in resource-limited settings.

    abstract:INTRODUCTION:The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The number of adolescents living with HIV is growing further due to persisting high HIV incidence rates among adolescents in low- and middle-income settings, partic...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,评审

    doi:10.1002/jia2.25002

    authors: Marcus R,Ferrand RA,Kranzer K,Bekker LG

    更新日期:2017-11-01 00:00:00

  • Efficacy of silk fibroin biomaterial vehicle for in vivo mucosal delivery of Griffithsin and protection against HIV and SHIV infection ex vivo.

    abstract:INTRODUCTION:The majority of new HIV infections occur through mucosal transmission. The availability of readily applicable and accessible platforms for anti-retroviral (ARV) delivery is critical for the prevention of HIV acquisition through sexual transmission in both women and men. There is a compelling need for devel...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.1002/jia2.25628

    authors: Crakes KR,Herrera C,Morgan JL,Olstad K,Hessell AJ,Ziprin P,LiWang PJ,Dandekar S

    更新日期:2020-10-01 00:00:00

  • Using a HIV registry to develop accurate estimates for the HIV care cascade - the Singapore experience.

    abstract:INTRODUCTION:Achieving UNAIDS 90-90-90 targets is a crucial step towards ending the AIDS epidemic. Many countries have published estimates of care cascades, although often with methodological limitations. We describe an approach that used the national HIV registry as a starting-point to determine the HIV care cascade a...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章

    doi:10.1002/jia2.25356

    authors: Ho ZJM,Huang F,Wong CS,Chua L,Ma S,Chen MI,Lee VJ

    更新日期:2019-07-01 00:00:00

  • Prevention literacy: community-based advocacy for access and ownership of the HIV prevention toolkit.

    abstract:INTRODUCTION:Critical technological advances have yielded a toolkit of HIV prevention strategies. This literature review sought to provide contextual and historical reflection needed to bridge the conceptual gap between clinical efficacy and community effectiveness (i.e. knowledge and usage) of existing HIV prevention ...

    journal_title:Journal of the International AIDS Society

    pub_type: 杂志文章,评审

    doi:10.7448/IAS.19.1.21092

    authors: Parker RG,Perez-Brumer A,Garcia J,Gavigan K,Ramirez A,Milnor J,Terto V Jr

    更新日期:2016-09-30 00:00:00