Your browser doesn't support javascript.
loading
Strengthening Existing Laboratory-Based Systems vs. Investing in Point-of-Care Assays for Early Infant Diagnosis of HIV: A Model-Based Cost-Effectiveness Analysis.
McCann, Nicole C; Cohn, Jennifer; Flanagan, Clare; Sacks, Emma; Mukherjee, Sushant; Walensky, Rochelle P; Adetunji, Oluwarantimi; Maeka, Kenneth K; Panella, Christopher; Chadambuka, Addmore; Mafaune, Haurovi; Odhiambo, Collins; Freedberg, Kenneth A; Ciaranello, Andrea L.
Afiliação
  • McCann NC; Department of Medicine, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.
  • Cohn J; Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland.
  • Flanagan C; Division of Infectious Disease, University of Pennsylvania, Philadelphia, PA.
  • Sacks E; Department of Medicine, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.
  • Mukherjee S; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC.
  • Walensky RP; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC.
  • Adetunji O; Department of Medicine, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.
  • Maeka KK; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.
  • Panella C; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA.
  • Chadambuka A; Harvard University Center for AIDS Research, Boston, MA.
  • Mafaune H; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC.
  • Odhiambo C; Early Infant Diagnosis Department, National Microbiology Reference Laboratory, Harare Central Hospital, Harare, Zimbabwe.
  • Freedberg KA; Department of Medicine, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA.
  • Ciaranello AL; Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe; and.
J Acquir Immune Defic Syndr ; 84 Suppl 1: S12-S21, 2020 07 01.
Article em En | MEDLINE | ID: mdl-32520910
BACKGROUND: To improve early infant HIV diagnosis (EID) programs, options include replacing laboratory-based tests with point-of-care (POC) assays or investing in strengthened systems for sample transport and result return. SETTING: We used the CEPAC-Pediatric model to examine clinical benefits and costs of 3 EID strategies in Zimbabwe for infants 6 weeks of age. METHODS: We examined (1) laboratory-based EID (LAB), (2) strengthened laboratory-based EID (S-LAB), and (3) POC EID (POC). LAB/S-LAB and POC assays differed in sensitivity (LAB/S-LAB 100%, POC 96.9%) and specificity (LAB/S-LAB 99.6%, POC 99.9%). LAB/S-LAB/POC algorithms also differed in: probability of result return (79%/91%/98%), time until result return (61/53/1 days), probability of initiating antiretroviral therapy (ART) after positive result (52%/71%/86%), and total cost/test ($18.10/$30.47/$30.71). We projected life expectancy (LE) and average lifetime per-person cost for all HIV-exposed infants. We calculated incremental cost-effectiveness ratios (ICERs) from discounted (3%/year) LE and costs in $/year-of-life saved (YLS), defining cost effective as an ICER <$580/YLS (reflecting programs providing 2 vs. 1 ART regimens). In sensitivity analyses, we varied differences between S-LAB and POC in result return probability, result return time, ART initiation probability, and cost. RESULTS: For infants who acquired HIV, LAB/S-LAB/POC led to projected one-year survival of 67.3%/69.9%/75.6% and undiscounted LE of 21.74/22.71/24.49 years. For all HIV-exposed infants, undiscounted LE was 63.35/63.38/63.43 years, at discounted lifetime costs of $200/220/240 per infant. In cost-effectiveness analysis, S-LAB was an inefficient use of resources; the ICER of POC vs. LAB was $830/YLS. CONCLUSIONS: Current EID programs will attain greater benefit from investing in POC EID rather than strengthening laboratory-based systems.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Testes Imediatos / Teste de HIV Tipo de estudo: Diagnostic_studies / Health_economic_evaluation / Prognostic_studies / Screening_studies Limite: Humans / Infant / Newborn Idioma: En Revista: J Acquir Immune Defic Syndr Assunto da revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Testes Imediatos / Teste de HIV Tipo de estudo: Diagnostic_studies / Health_economic_evaluation / Prognostic_studies / Screening_studies Limite: Humans / Infant / Newborn Idioma: En Revista: J Acquir Immune Defic Syndr Assunto da revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Ano de publicação: 2020 Tipo de documento: Article