Document Detail


A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa.
MedLine Citation:
PMID:  21297484     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Richard C Waters; Jan Ostermann; Travis D Reeves; Max F Masnick; Nathan M Thielman; John A Bartlett; John A Crump
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  56     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-11-01     Completed Date:  2011-11-15     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  443-52     Citation Subset:  IM; X    
Affiliation:
Duke Global Health Institute, Duke University, Durham, NC 27701, USA.
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MeSH Terms
Descriptor/Qualifier:
AIDS Serodiagnosis / economics*,  statistics & numerical data*
Adult
Africa South of the Sahara / epidemiology
Antiretroviral Therapy, Highly Active / methods*
Cost-Benefit Analysis
Counseling / economics*
Female
HIV Infections / diagnosis*,  drug therapy,  economics,  epidemiology*
HIV Seropositivity / diagnosis,  drug therapy,  economics
Health Care Costs
Humans
Incidence
Male
Models, Economic*
Pregnancy
Quality-Adjusted Life Years
Sensitivity and Specificity
Young Adult
Grant Support
ID/Acronym/Agency:
D43 PA-03-018//PHS HHS; D43 TW006732-08/TW/FIC NIH HHS; P30 AI 64518/AI/NIAID NIH HHS; P30 AI064518/AI/NIAID NIH HHS; P30 AI064518-07/AI/NIAID NIH HHS; U01 AI-03-036/AI/NIAID NIH HHS; U01 AI062563/AI/NIAID NIH HHS; U01 AI062563-04/AI/NIAID NIH HHS; U01 AI067854/AI/NIAID NIH HHS; U01 AI069484/AI/NIAID NIH HHS; U01 AI069484-01/AI/NIAID NIH HHS; U01 AI069484-06/AI/NIAID NIH HHS; U19 AI067854/AI/NIAID NIH HHS; U19 AI067854-07/AI/NIAID NIH HHS
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