دورية أكاديمية
أعرض في EDS

Field performance and cost-effectiveness of a point-of-care triage test for HIV virological failure in Southern Africa.

التفاصيل البيبلوغرافية
العنوان: Field performance and cost-effectiveness of a point-of-care triage test for HIV virological failure in Southern Africa.
المؤلفون: Saura-Lázaro A; Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain., Bock P; Department of Pediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa., Bogaart EVD; Mondial Diagnostics, Amsterdam, The Netherlands., van Vliet J; Mondial Diagnostics, Amsterdam, The Netherlands., Granés L; Department of Preventive Medicine and Epidemiology, Hospital Clínic de Barcelona, Barcelona, Spain., Nel K; Department of Pediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa., Naidoo V; Department of Pediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa., Scheepers M; Department of Pediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa., Saunders Y; Department of Pediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa., Leal N; Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain., Ramponi F; Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain., Paulussen R; Mondial Diagnostics, Amsterdam, The Netherlands., de Wit TR; Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.; Department of Global Health, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands., Naniche D; Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain., López-Varela E; Barcelona Institute for Global Health (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
المصدر: Journal of the International AIDS Society [J Int AIDS Soc] 2023 Oct; Vol. 26 (10), pp. e26176.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: John Wiley & Sons, Inc Country of Publication: Switzerland NLM ID: 101478566 Publication Model: Print Cited Medium: Internet ISSN: 1758-2652 (Electronic) Linking ISSN: 17582652 NLM ISO Abbreviation: J Int AIDS Soc Subsets: MEDLINE
أسماء مطبوعة: Publication: 2017- : Hoboken, NJ : John Wiley & Sons, Inc
Original Publication: [London] : BioMed Central
مواضيع طبية MeSH: HIV Infections*/diagnosis , HIV Infections*/drug therapy , Anti-HIV Agents*/therapeutic use , Anti-HIV Agents*/pharmacology, Adult ; Humans ; Chemokine CXCL10/pharmacology ; Chemokine CXCL10/therapeutic use ; Cost-Benefit Analysis ; Point-of-Care Systems ; Triage ; Cross-Sectional Studies ; Africa, Southern ; Viral Load
مستخلص: Introduction: Antiretroviral therapy (ART) monitoring using viral load (VL) testing is challenging in high-burden, limited-resources settings. Chemokine IP-10 (interferon gamma-induced protein 10) strongly correlates with human immunodeficiency virus (HIV) VL. Its determination could serve to predict virological failure (VF) and to triage patients requiring VL testing. We assessed the field performance of a semi-quantitative IP-10 lateral flow assay (LFA) for VF screening in South Africa, and the cost-effectiveness of its implementation in Mozambique.
Methods: A cross-sectional study was conducted between June and December 2021 in three primary health clinics in the Western Cape. Finger prick capillary blood was collected from adults on ART for ≥1 year for direct application onto the IP-10 LFA (index test) and compared with a plasma VL result ≤1 month prior (reference test). We estimated the area under the receiver operating characteristic curves (AUC), sensitivity and specificity, to evaluate IP-10 LFA prediction of VF (VL>1000 copies/ml). A decision tree model was used to investigate the cost-effectiveness of integrating IP-10 LFA combined with VL testing into the current Mozambican ART monitoring strategy. Averted disability-adjusted life years (DALYs) and HIV acquisitions, and incremental cost-effectiveness ratios were estimated.
Results: Among 209 participants (median age 38 years and 84% female), 18% had VF. Median IP-10 LFA values were higher among individuals with VF compared to those without (24.0 vs. 14.6; p<0.001). The IP-10 LFA predicted VF with an AUC = 0.76 (95% confidence interval (CI) 0.67-0.85), 91.9% sensitivity (95% CI 78.1-98.3) and 35.1% specificity (95% CI 28.0-42.7). Integrating the IP-10 LFA in a setting with 20% VF prevalence and 61% VL testing coverage could save 13.0% of costs and avert 14.9% of DALYs and 55.7% new HIV acquisitions. Furthermore, its introduction was estimated to reduce the total number of routine VL tests required for ART monitoring by up to 68%.
Conclusions: The IP-10 LFA is an effective VF triage test for routine ART monitoring. Combining a highly sensitive, low-cost IP-10 LFA-based screening with targeted VL confirmatory testing could result in significant healthcare quality improvements and cost savings in settings with limited access to VL testing.
(© 2023 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)
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فهرسة مساهمة: Keywords: CXC chemokine IP-10; Southern Africa; cost-effectiveness analysis; human immunodeficiency virus; point-of-care test; therapeutic drug monitoring
المشرفين على المادة: 0 (Chemokine CXCL10)
0 (Anti-HIV Agents)
تواريخ الأحداث: Date Created: 20231007 Date Completed: 20231009 Latest Revision: 20231016
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC10558896
DOI: 10.1002/jia2.26176
PMID: 37803882
قاعدة البيانات: MEDLINE
الوصف
تدمد:1758-2652
DOI:10.1002/jia2.26176