Projecting the epidemiological effect, cost-effectiveness and transmission of HIV drug resistance in Vietnam associated with viral load monitoring strategies.
J Antimicrob Chemother
; 71(5): 1367-79, 2016 May.
Article
in En
| MEDLINE
| ID: mdl-26869689
ABSTRACT
OBJECTIVES:
The objective of this study was to investigate the potential epidemiological impact of viral load (VL) monitoring and its cost-effectiveness in Vietnam, where transmitted HIV drug resistance (TDR) prevalence has increased from <5% to 5%-15% in the past decade.METHODS:
Using a population-based mathematical model driven by data from Vietnam, we simulated scenarios of various combinations of VL testing coverage, VL thresholds for second-line ART initiation and availability of HIV drug-resistance tests. We assessed the cost per disability-adjusted life year (DALY) averted for each scenario.RESULTS:
Projecting expected ART scale-up levels, to approximately double the number of people on ART by 2030, will lead to an estimated 18â510 cases (95% CI 9120-34â600 cases) of TDR and 55â180 cases (95% CI 40â540-65â900 cases) of acquired drug resistance (ADR) in the absence of VL monitoring. This projection corresponds to a TDR prevalence of 16% (95% CI 11%-24%) and ADR of 18% (95% CI 15%-20%). Annual or biennial VL monitoring with 30% coverage is expected to relieve 12%-31% of TDR (2260-5860 cases), 25%-59% of ADR (9620-22â650 cases), 2%-6% of HIV-related deaths (360-880 cases) and 19â270-51â400 DALYs during 2015-30. The 30% coverage of VL monitoring is estimated to cost US$4848-5154 per DALY averted. The projected additional cost for implementing this strategy is US$105-268 million over 2015-30.CONCLUSIONS:
Our study suggests that a programmatically achievable 30% coverage of VL monitoring can have considerable benefits for individuals and leads to population health benefits by reducing the overall national burden of HIV drug resistance. It is marginally cost-effective according to common willingness-to-pay thresholds.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Antiviral Agents
/
HIV Infections
/
HIV
/
Drug Monitoring
/
Viral Load
/
Drug Resistance, Viral
Type of study:
Health_economic_evaluation
/
Observational_studies
/
Risk_factors_studies
Aspects:
Patient_preference
Limits:
Adult
/
Female
/
Humans
/
Male
Country/Region as subject:
Asia
Language:
En
Journal:
J Antimicrob Chemother
Year:
2016
Document type:
Article
Affiliation country:
Vietnam