Improvement of antiretroviral therapy (ART) regimen switching practices and implementation of pretreatment drug resistance (PDR) testing are two potential approaches to improve health outcomes for children living with HIV. We developed a microsimulation model of disease progression and treatment focused on children with perinatally acquired HIV in sub-Saharan Africa who initiate ART at 3 years of age. We evaluated the cost-effectiveness of diagnostic-based strategies (improved switching and PDR testing), over a 10-year time horizon, in settings without and with pediatric dolutegravir (DTG) availability as first-line ART. The improved switching strategy increases the probability of switching to second-line ART when virologic failure is diagnosed through viral load testing. The PDR testing strategy involves a one-time PDR test prior to ART initiation to guide choice of initial regimen. When DTG is not available, PDR testing is dominated by the improved switching strategy, which has an incremental cost-effectiveness ratio (ICER) of USD 579/life-year gained (LY), relative to the status quo. If DTG is available, improved switching has a similar ICER (USD 591/LY) relative to the DTGstatus quo. Even when substantial financial investment is needed to achieve improved regimen switching practices, the improved switching strategy still has the potential to be cost-effective in a wide range of sub-Saharan African countries. Our analysis highlights the importance of strengthening existing laboratory monitoring systems to improve the health of children living with HIV.

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This paper concerned with the design, development and testing of a gamma Stirling engine. The experimental apparatuses were also developed to determine the engine performance at varying speeds and hot-side temperatures. The measurements were then compared with the calculated power. In the experiment, an electric heater was used as the heat source, and the rope-brake method was used to measure engine torque. From the experiment, the lowest different temperature of the engine that could start the engine was 63.8 °C, the engine maximum speed was 81.0 rpm, and the maximum output power of the engine was 0.022 W at the working temperature of 148 °C and speed of 54.0 rpm. The maximum overall efficiency of the apparatus was 0.0646% at the same conditions.