A Cost-Effectiveness Analysis of Alternative HIV Retesting Strategies in Sub-Saharan Africa

Waters, Richard C.; Ostermann, Jan; Reeves, Travis D.; Masnick, Max; Thielman, Nathan M.; Bartlett, John A.; Crump, John A.

doi:10.1097/qai.0b013e3182118f8c

Cited by 10 publications

(15 citation statements)

References 63 publications

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“…The high HIV seroincidence rate in this and other cohorts of repeat HCT clients in sub-Saharan Africa, despite repeatedly receiving HIV education, suggests a need to aggressively tailor education and prevention interventions for this particular high risk group. Finally, the impact of HCT on HIV prevention among HIV-seronegative clients in sub-Saharan Africa requires further study and the effect of repeat testing beyond the initial repeat test needs to be explored as recommendations for regular retesting are rolled out (Waters et al , 2011). The continued assessment of HIV knowledge and promotion of behavior change is essential.…”

Section: Discussionmentioning

confidence: 99%

Changes in HIV risk behavior and seroincidence among clients presenting for repeat HIV counseling and testing in Moshi, Tanzania

et al. 2012

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While HIV counseling and testing (HCT) has been considered an HIV preventive measure in Africa, data are limited describing behavior changes following HCT. This study evaluated behavior changes and estimated HIV seroincidence rate among returning HCT clients. Repeat and one-time testing clients receiving HCT services in Moshi, Tanzania were identified. Information about sociodemographic characteristics, HIV behaviors and testing reasons were collected, along with HIV testing. 6,727 clients presented at least once for HCT; 1,235 (18.4%) were HIV seropositive, median age was 29.7 years and 3,712 (55.3%) were women. 1,382 repeat and 4,272 one-time testers were identified. Repeat testers were more likely to be male, older, married or widowed, and testing because of unfaithful partner or new sexual partner. One-time testers were more likely to be students and testing due to illness. At second test, repeat testers were more likely to report that partners had received HIV testing, not have concurrent partners, not suspect partners have HIV, and have partners who did not have other partners. Clients who intended to change behaviors after the first test were more likely to report having changed behaviors by remaining abstinent (OR 2.58; p<0.0001) or using condoms (OR 2.00; p=0.006) at the second test. HIV seroincidence rate was 1.49 cases/100 person-years. Clients presenting for repeat HCT reported some reduction of risky behavior, improved knowledge of sexual practices and HIV serostatus of their partners. Promoting behavior change through HCT should continue to be a focus of HIV prevention efforts in sub-Saharan Africa.

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Section: Discussionmentioning

confidence: 99%

Changes in HIV risk behavior and seroincidence among clients presenting for repeat HIV counseling and testing in Moshi, Tanzania

et al. 2012

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“…The lack of clarity on the specific frequency and time points to conduct retesting during pregnancy and the postpartum period can create confusion for programme implementers about when to offer retesting, contributing to suboptimal implementation. In contrast, other programmes may be offering retesting more frequently than needed, and wasting limited public health resources on unnecessary retesting . Countries need additional data on the impact of retesting during pregnancy, labour/delivery and postpartum to appropriately allocate HIV resources, including allocation within PMTCT programmes.…”

Section: Introductionmentioning

confidence: 99%

Retest and treat: a review of national HIV retesting guidelines to inform elimination of mother‐to‐child HIV transmission (EMTCT) efforts

et al. 2019

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Introduction High maternal HIV incidence contributes substantially to mother‐to‐child HIV transmission ( MTCT ) in some settings. Since 2006, HIV retesting during the third trimester and breastfeeding has been recommended by the World Health Organization in higher prevalence (≥5%) settings to reduce MTCT . However, many countries lack clarity on when and how often to retest pregnant and postpartum women to optimize resources and service delivery. We reviewed and characterized national guidelines on maternal retesting based on timing and frequency. Methods We identified 52 countries to represent variations in HIV prevalence, geography, and MTCT priority and searched available national MTCT , HIV testing and HIV treatment policies published between 2007 and 2017 for recommendations on retesting during pregnancy, labour/delivery and postpartum. Recommended retesting frequency and timing was extracted. Country HIV prevalence was classified as: very low (<1%), low (1% to 5%), intermediate (>5 to <15%) and high (≥15%). Women with unknown HIV status at delivery/postpartum were included in retesting guidelines. Results and discussion Overall, policies from 49 countries were identified; 51% from 2015 or later and most (n = 25) were from Africa. Four countries were high HIV prevalence, seven intermediate, sixteen low and twenty‐two very low. Most (n = 31) had guidance on universal voluntary opt‐out HIV testing at the first antenatal care ( ANC ) visit. Beyond the first ANC visit, the majority (78%, n = 38) had guidance on retesting; 22 recommended retesting all women with unknown/negative status, five only if unknown HIV status, three in pregnancy based on risk and eight combining these approaches. Retesting was universally recommended during pregnancy, labour/delivery, and postpartum for all high prevalence settings and four of seven intermediate prevalence settings. Five UNAIDS priority countries for EMTCT with low/very low HIV prevalence, but high/intermediate MTCT , had no guidance on retesting. Conclusions Retesting guidelines for pregnant and postpartum women were ubiquitous in high prevalence countries and defined in some intermediate prevalence countries, but absent in some low HIV prevalence countries with high MTCT . Countries may require additional guidance on how to optimize mate...

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“…The majority of the evidence came from 20 modelling studies (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). There was one descriptive study (38); three non-economic modelling studies (39)(40)(41); one cohort study (42); one cross-sectional study (43); and one mixed-methods study (descriptive and modelling) (44).…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies, all of which were cost-effectiveness models, addressed optimal testing frequencies in the general population considered at low risk for HIV, with incidence ranging from 0.0084% to 4% per year (20,23,24,(27)(28)(29)(30)(32)(33)(34)36,37,45). Recommended testing frequencies ranged from a one-time test to annual testing, with the largest proportion (n=5) advocating for a one-time test (23,24,30,36,37).…”

Section: General Populationmentioning

confidence: 99%

Evidence for optimal HIV screening and testing intervals in HIV-negative individuals from various risk groups: A systematic review

Timmerman

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et al. 2018

CCDR

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Background: Human immunodeficiency virus (HIV) testing plays a crucial role in Canada's HIV prevention and treatment efforts and is the first step to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets; however, how often Canadians, including populations at increased risk of HIV exposure, should be tested is unclear. We conducted a systematic literature review to determine the optimal HIV screening and testing intervals. Objective: To examine the current evidence on HIV testing intervals in HIV-negative individuals from various risk groups and to assess the potential harms and patients' values and preferences associated with different testing frequencies. Methods: We searched MEDLINE/PubMed, Scopus, Embase, the Cochrane Library, PsychINFO and EconLit for studies on different frequencies of HIV testing published between January 2000 and September 2016. An additional search was conducted for grey literature published between January 2000 and October 2016. Data extraction included study characteristics, participants, exposure, outcomes and economic variables. The quality of the studies was assessed and results summarized. Results: Of the 2,702 articles identified from the searches, 27 met the inclusion criteria for review. This included assessments of HIV testing intervals among the general population, men who have sex with men, people who use injection drugs and sex workers. Optimal testing intervals across risk groups ranged from one-time testing to every three months. Data from modelling studies may not be representative of the Canadian context. Few studies identified potential harms of increased screening, specifically an increase in both false positive and false negative results. There were only two studies that addressed patient values and preferences concerning HIV screening, which suggested that the majority of participants were amenable to routine screening through their primary care provider. Conclusion: There was insufficient evidence to support optimal HIV screening and testing intervals for different populations. Context-specific factors, such as budget allocation, human resources, local epidemiology, socioeconomic factors and risk behaviours, along with clinical judgement, inform whom and how often to screen, suggesting the need for research specific to Canada. Research on patient preferences as well as the benefits and harms of more frequent screening are also indicated.

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A Cost-Effectiveness Analysis of Alternative HIV Retesting Strategies in Sub-Saharan Africa

Cited by 10 publications

References 63 publications

Changes in HIV risk behavior and seroincidence among clients presenting for repeat HIV counseling and testing in Moshi, Tanzania

Changes in HIV risk behavior and seroincidence among clients presenting for repeat HIV counseling and testing in Moshi, Tanzania

Retest and treat: a review of national HIV retesting guidelines to inform elimination of mother‐to‐child HIV transmission (EMTCT) efforts

Evidence for optimal HIV screening and testing intervals in HIV-negative individuals from various risk groups: A systematic review

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