A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa.
J Acquir Immune Defic Syndr
; 56(5): 443-52, 2011 Apr 15.
Article
em En
| MEDLINE
| ID: mdl-21297484
ABSTRACT
BACKGROUND:
Guidelines in sub-Saharan Africa on when HIV-seronegative persons should retest range from never to annually for lower-risk populations and from annually to every 3 months for high-risk populations.METHODS:
We designed a mathematical model to compare the cost-effectiveness of alternative HIV retesting frequencies. Cost of HIV counseling and testing, linkage to care, treatment costs, disease progression, and mortality, and HIV transmission are modeled for three hypothetical cohorts with posited annual HIV incidence of 0.8%, 1.3%, and 4.0%, respectively. The model compared costs, quality-adjusted life-years gained, and secondary infections averted from testing intervals ranging from 3 months to 30 years. Input parameters from sub-Saharan Africa were used and explored in sensitivity analyses.RESULTS:
Accounting for secondary infections averted, the most cost-effective testing frequency was every 7.5 years for 0.8% incidence, every 5 years for 1.3% incidence, and every 2 years for 4.0% incidence. Optimal testing strategies and their relative cost-effectiveness were most sensitive to assumptions about HIV counseling and testing and treatment costs, rates of CD4 decline, rates of HIV transmission, and whether tertiary infections averted were taken into account.CONCLUSIONS:
While higher risk populations merit more frequent HIV testing than low risk populations, regular retesting is beneficial even in low-risk populations. Our data demonstrate benefits of tailoring testing intervals to resource constraints and local HIV incidence rates.
Texto completo:
1
Temas:
ECOS
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Aspectos_gerais
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Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Sorodiagnóstico da AIDS
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Infecções por HIV
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Modelos Econômicos
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Aconselhamento
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Terapia Antirretroviral de Alta Atividade
Tipo de estudo:
Diagnostic_studies
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Guideline
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Health_economic_evaluation
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Incidence_studies
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Prognostic_studies
Aspecto:
Patient_preference
Limite:
Adult
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Female
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Humans
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Male
/
Pregnancy
País/Região como assunto:
Africa
Idioma:
En
Revista:
J Acquir Immune Defic Syndr
Assunto da revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Ano de publicação:
2011
Tipo de documento:
Article
País de afiliação:
Estados Unidos