Document Detail


Cost-effectiveness of routine rapid human immunodeficiency virus antibody testing before DNA-PCR testing for early diagnosis of infants in resource-limited settings.
MedLine Citation:
PMID:  20050391     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Infants born to HIV-infected women should receive HIV testing to allow early diagnosis and treatment. Recommendations for resource-limited settings stress laboratory-based virologic assays. While effective, these tests are logistically complex and expensive. This study explored the cost-effectiveness of incorporating initial screening with rapid HIV tests (RHT) into the conventional testing algorithm to screen-out HIV-uninfected infants, thereby reducing the need for costly virologic testing. METHODS: Data on HIV prevalence, RHT sensitivity and specificity, and costs were collected from 820 HIV-exposed children (1.5-18 months) attending 2 postnatal screening programs in Uganda during July 2005 to December 2006. Cost-effectiveness models compared the conventional testing algorithm DNA polymerase chain reaction (DNA-PCR with Roche Amplicor v1.5) with a modified algorithm (initial RHT to screen-out HIV-uninfected infants before DNA-PCR). RESULTS: The model estimated that the conventional algorithm would identify 94.3% (91.8%-94.7%) of HIV-infected infants, compared with 87.8% (79.4%-90.5%) for a modified algorithm using RHT (HIV 1/2 Determine) and excluding the need for DNA-PCR for HIV antibody-negative infants. Costs per infant were $23.47 ($23.32-$23.76) for the conventional algorithm and between $22.75 ($21.89-$23.31) and $7.58 ($6.41-$10.75) for the modified algorithm, depending on infant age and symptoms. Compared with the conventional algorithm, costs per HIV-infected infant identified using the modified algorithm were higher in 1.5-to 3-month-old infants, but significantly lower in 3-month-old and older infants. Models replicating the whole infant testing program showed the modified algorithm would have marginally lower sensitivity, but would reduce total program costs by 27% to 40%, producing an incremental cost-effectiveness ratio of $1489 ($686-$6781) for the conventional versus modified algorithms. CONCLUSIONS: Screening infants with RHT before DNA-PCR is cost-effective in infants 3 months old or older. Incorporating RHT into early infant testing programs could improve cost-effectiveness and reduce program costs.
Authors:
Nicolas A Menzies; Jaco Homsy; Jeannie Y Chang Pitter; Christian Pitter; Jonathan Mermin; Robert Downing; Thomas Finkbeiner; John Obonyo; Adeodata Kekitiinwa; Jordan Tappero; John M Blandford
Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  28     ISSN:  1532-0987     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-12-31     Completed Date:  2010-02-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  819-25     Citation Subset:  IM    
Affiliation:
Centers for Disease Control and Prevention (CDC), Global AIDS Program, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA, USA. nmenzies@fas.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Clinical Laboratory Techniques / economics*,  methods
DNA, Viral / genetics
Developing Countries
Early Diagnosis
Female
HIV Antibodies / blood*
HIV Infections / diagnosis*,  economics*,  epidemiology
HIV-1 / genetics,  immunology,  isolation & purification*
Health Manpower
Humans
Immunoassay / economics*,  methods
Infant
Male
Polymerase Chain Reaction / economics*,  methods
Sensitivity and Specificity
Uganda / epidemiology
Chemical
Reg. No./Substance:
0/DNA, Viral; 0/HIV Antibodies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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