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Health Impact and Cost-Effectiveness of HIV Testing, Linkage, and Early Antiretroviral Treatment in the Botswana Combination Prevention Project.
Resch, Stephen C; Foote, Julia H A; Wirth, Kathleen E; Lasry, Arielle; Scott, Justine A; Moore, Janet; Shebl, Fatma M; Gaolathe, Tendani; Feser, Mary K; Lebelonyane, Refeletswe; Hyle, Emily P; Mmalane, Mompati O; Bachanas, Pamela; Yu, Liyang; Makhema, Joseph M; Holme, Molly Pretorius; Essex, Max; Alwano, Mary Grace; Lockman, Shahin; Freedberg, Kenneth A.
Afiliación
  • Resch SC; Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA.
  • Foote JHA; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Wirth KE; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
  • Lasry A; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA.
  • Scott JA; Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA.
  • Moore J; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Shebl FM; Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA.
  • Gaolathe T; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Feser MK; Harvard Medical School, Boston, MA.
  • Lebelonyane R; Botswana-Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana.
  • Hyle EP; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Mmalane MO; Botswana Ministry of Health and Wellness, Gaborone, Botswana.
  • Bachanas P; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Yu L; Harvard Medical School, Boston, MA.
  • Makhema JM; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA.
  • Holme MP; Harvard University Center for AIDS Research, Cambridge, MA.
  • Essex M; Botswana-Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana.
  • Alwano MG; Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA.
  • Lockman S; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA.
  • Freedberg KA; Botswana-Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana.
J Acquir Immune Defic Syndr ; 90(4): 399-407, 2022 08 01.
Article en En | MEDLINE | ID: mdl-35420554
BACKGROUND: The Botswana Combination Prevention Project tested the impact of combination prevention (CP) on HIV incidence in a community-randomized trial. Each trial arm had ∼55,000 people, 26% HIV prevalence, and 72% baseline ART coverage. Results showed intensive testing and linkage campaigns, expanded antiretroviral treatment (ART), and voluntary male medical circumcision referrals increased coverage and decreased incidence over ∼29 months of follow-up. We projected lifetime clinical impact and cost-effectiveness of CP in this population. SETTING: Rural and periurban communities in Botswana. METHODS: We used the Cost-Effectiveness of Preventing AIDS Complications model to estimate lifetime health impact and cost of (1) earlier ART initiation and (2) averting an HIV infection, which we applied to incremental ART initiations and averted infections calculated from trial data. We determined the incremental cost-effectiveness ratio [US$/quality-adjusted life-years (QALY)] for CP vs. standard of care. RESULTS: In CP, 1418 additional people with HIV initiated ART and an additional 304 infections were averted. For each additional person started on ART, life expectancy increased 0.90 QALYs and care costs increased by $869. For each infection averted, life expectancy increased 2.43 QALYs with $9200 in care costs saved. With CP, an additional $1.7 million were spent on prevention and $1.2 million on earlier treatment. These costs were mostly offset by decreased care costs from averted infections, resulting in an incremental cost-effectiveness ratio of $79 per QALY. CONCLUSIONS: Enhanced HIV testing, linkage, and early ART initiation improve life expectancy, reduce transmission, and can be cost-effective or cost-saving in settings like Botswana.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por VIH Tipo de estudio: Clinical_trials / Diagnostic_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Humans / Male País/Región como asunto: Africa Idioma: En Revista: J Acquir Immune Defic Syndr Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por VIH Tipo de estudio: Clinical_trials / Diagnostic_studies / Health_economic_evaluation / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Humans / Male País/Región como asunto: Africa Idioma: En Revista: J Acquir Immune Defic Syndr Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos