دورية أكاديمية
أعرض في EDS

Testing strategies to detect acute and prevalent HIV infection in adult outpatients seeking healthcare for symptoms compatible with acute HIV infection in Kenya: a cost-effectiveness analysis.

التفاصيل البيبلوغرافية
العنوان: Testing strategies to detect acute and prevalent HIV infection in adult outpatients seeking healthcare for symptoms compatible with acute HIV infection in Kenya: a cost-effectiveness analysis.
المؤلفون: Babigumira JB; Saw Swee Hock School of Public Health, National University Singapore, Singapore josephbabigumira@gmail.com., Agutu CA; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya., Hamilton DT; Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA., van der Elst E; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya., Hassan A; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya., Gichuru E; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya., Mugo PM; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya., Farquhar C; Department of Medicine, University of Washington, Seattle, Washington, USA., Ndung'u T; Africa Health Research Institute, Durban, South Africa., Sirengo M; National AIDS & STI Control Programme, Nairobi, Kenya., Chege W; National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA., Goodreau SM; Departments of Anthropology and Epidemiology, University of Washington, Seattle, Washington, USA., Sanders EJ; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.; Nuffield Department of Medicine, University of Oxford, Headington, UK., M Graham S; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.; Departments of Medicine, Global Health, and Epidemiology, University of Washington School of Medicine, Seattle, Washington, USA.
المصدر: BMJ open [BMJ Open] 2022 Sep 29; Vol. 12 (9), pp. e058636. Date of Electronic Publication: 2022 Sep 29.
نوع المنشور: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
مواضيع طبية MeSH: Acquired Immunodeficiency Syndrome* , HIV Infections*/diagnosis , Nucleic Acids*, Adult ; Cost-Benefit Analysis ; Delivery of Health Care ; Humans ; Kenya/epidemiology ; Outpatients
مستخلص: Background: Detection of acute and prevalent HIV infection using point-of-care nucleic acid amplification testing (POC-NAAT) among outpatients with symptoms compatible with acute HIV is critical to HIV prevention, but it is not clear if it is cost-effective compared with existing HIV testing strategies.
Methods: We developed and parametrised a decision tree to compare the cost-effectiveness of (1) provider-initiated testing and counselling (PITC) using rapid tests, the standard of care; (2) scaled-up provider-initiated testing and counselling (SU-PITC) in which all patients were tested with rapid tests unless they opted out; and (3) opt-out testing and counselling using POC-NAAT, which detects both acute and prevalent infection. The model-based analysis used data from the Tambua Mapema Plus randomised controlled trial of a POC-NAAT intervention in Kenya, supplemented with results from a stochastic, agent-based network model of HIV-1 transmission and data from published literature. The analysis was conducted from the perspective of the Kenyan government using a primary outcome of cost per disability-adjusted life-year (DALY) averted over a 10-year time horizon.
Results: After analysing the decision-analytical model, the average per patient cost of POC-NAAT was $214.9 compared with $173.6 for SU-PITC and $47.3 for PITC. The mean DALYs accumulated per patient for POC-NAAT were 0.160 compared with 0.176 for SU-PITC and 0.214 for PITC. In the incremental analysis, SU-PITC was eliminated due to extended dominance, and the incremental cost-effectiveness ratio (ICER) comparing POC-NAAT to PITC was $3098 per DALY averted. The ICER was sensitive to disability weights for HIV/AIDS and the costs of antiretroviral therapy.
Conclusion: POC-NAAT offered to adult outpatients in Kenya who present for care with symptoms compatible with AHI is cost-effective and should be considered for inclusion as the standard of HIV testing in this population.
Trial Registration Number: Tambua Mapema ("Discover Early") Plus study (NCT03508908) conducted in Kenya (2017-2020) i.e., Post-results.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
References: PLoS One. 2011;6(11):e27625. (PMID: 22110698)
Lancet Glob Health. 2015 Nov;3(11):e712-23. (PMID: 26475018)
PLoS One. 2021 Feb 5;16(2):e0246444. (PMID: 33544736)
PLoS One. 2019 Jun 27;14(6):e0218369. (PMID: 31246963)
JMIR Res Protoc. 2020 Aug 7;9(8):e16198. (PMID: 32763882)
AIDS. 2018 Jan 14;32(2):233-241. (PMID: 29135576)
J Clin Virol. 2017 Aug;93:81-84. (PMID: 28351688)
PLoS One. 2019 Mar 22;14(3):e0213865. (PMID: 30901343)
Value Health. 2016 Dec;19(8):929-935. (PMID: 27987642)
Pharmacoeconomics. 2014 Jun;32(6):525-31. (PMID: 24791735)
AIDS. 2011 Jun 1;25(9):1219-24. (PMID: 21505300)
PLoS One. 2011;6(12):e28792. (PMID: 22194914)
PLoS One. 2011 Mar 28;6(3):e18193. (PMID: 21464895)
Pharmacoeconomics. 2009;27(11):903-17. (PMID: 19888791)
Cost Eff Resour Alloc. 2021 Feb 4;19(1):7. (PMID: 33541364)
J Manag Care Spec Pharm. 2019 Oct;25(10):1133-1139. (PMID: 31556818)
BMJ Glob Health. 2018 Nov 5;3(6):e000964. (PMID: 30483412)
BMC Health Serv Res. 2016 Oct 10;16(1):563. (PMID: 27724908)
AIDS Res Treat. 2019 May 02;2019:4170615. (PMID: 31186955)
PLoS One. 2012;7(9):e45176. (PMID: 23028828)
J Acquir Immune Defic Syndr. 2022 Aug 15;90(5):553-561. (PMID: 35510854)
Clin Infect Dis. 2016 Feb 15;62(4):501-511. (PMID: 26508512)
AIDS. 2015 Dec;29 Suppl 3:S221-30. (PMID: 26562811)
HIV Med. 2022 Jan;23(1):16-28. (PMID: 34431196)
BMJ. 2013 Mar 25;346:f1049. (PMID: 23529982)
N Engl J Med. 2011 May 19;364(20):1943-54. (PMID: 21591946)
Lancet HIV. 2017 Feb;4(2):e74-e82. (PMID: 27913227)
معلومات مُعتمدة: P2C HD042828 United States HD NICHD NIH HHS; R01 AI124968 United States AI NIAID NIH HHS; United Kingdom WT_ Wellcome Trust
فهرسة مساهمة: Keywords: HEALTH ECONOMICS; HIV & AIDS; Health economics; Health policy
سلسلة جزيئية: ClinicalTrials.gov NCT03508908
المشرفين على المادة: 0 (Nucleic Acids)
تواريخ الأحداث: Date Created: 20220929 Date Completed: 20221003 Latest Revision: 20230127
رمز التحديث: 20230127
مُعرف محوري في PubMed: PMC9528633
DOI: 10.1136/bmjopen-2021-058636
PMID: 36175097
قاعدة البيانات: MEDLINE
الوصف
تدمد:2044-6055
DOI:10.1136/bmjopen-2021-058636