Cost-effectiveness Analysis Along the Continuum of HIV Care: How Can We Optimize the Effect of HIV Treatment as Prevention Programs?

Nosyk, Bohdan; Krebs, Emanuel; Eyawo, Oghenowede; Min, Jeong Eun; Barrios, Rolando; Montaner, Julio S. G.

doi:10.1007/s11904-014-0227-7

Cited by 19 publications

(14 citation statements)

References 61 publications

(33 reference statements)

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“…Citizenship theories may also need to be 'tested' with empirical studies regarding rationing and treatment reductions, at a time when engagement and retention in care is increasingly articulated along the lines of cost effectiveness debates in health systems (Nosyk et al, 2014;Stover et al, 2014). Furthermore, as well as their health benefits, the added prevention effects of HIV viral suppression also represent significant cost savings (Gupta, Williams and Montaner, 2014).…”

Section: Resultsmentioning

confidence: 99%

The biopolitics of engagement and the HIV cascade of care: a synthesis of the literature on patient citizenship and antiretroviral therapy

Paparini

Rhodes

2016

Critical Public Health

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The 'cascade of care' construct is increasingly used in public health to map the trajectory of local HIV epidemics and of different HIV populations. The notion of 'patient engagement' is key to the progress of people living with HIV through the various 'steps' of the cascade as currently conceptualised. The public health literature on the definition, measurement, and interpretation of cascade of care frameworks is growing in parallel with critical social science literature analysing patient engagement through the lenses of 'patient citizenship' theories. In this paper, we review qualitative literature on HIV treatment, adherence to antiretroviral therapy, and care engagement that draws upon the interlinked concepts of therapeutic and biological citizenship. We aim to offer a critique of the cascade of care construct using empirical data from research studies published since 2005 that were influenced by these two concepts. In so doing, the paper places public health literature on the cascade of care in dialogue with in-depth qualitative and ethnographic approaches, to unpack the understandings and processes shaping patient engagement in HIV treatment and care in different settings. The paper also examines the contributions and limitations of the concepts of biological and therapeutic citizenship as argued by a number of scholars here reviewed.

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Section: Resultsmentioning

confidence: 99%

The biopolitics of engagement and the HIV cascade of care: a synthesis of the literature on patient citizenship and antiretroviral therapy

Paparini

Rhodes

2016

Critical Public Health

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“…Although a wide variety of interventions have proven effective in improving HIV care along the continuum, and many more currently being tested in a wide range of settings [13], systematic reviews summarizing cost-effectiveness analysis for HIV care interventions noted large knowledge gaps in the literature, particularly on linkage interventions [14,15]. Moreover, many HIV care interventions are executed without formal economic evaluations [16,17,18].…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of the ‘One4All’ HIV Linkage Intervention in Guangxi Zhuang Autonomous Region, China

Zang

Tang²,

Min

et al. 2016

PLoS ONE

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BackgroundIn Guangxi Zhuang Autonomous Region, China, an estimated 80% of newly-identified antiretroviral therapy (ART)-eligible patients are not engaged in ART. Delayed ART uptake ultimately translates into high rates of HIV morbidity, mortality, and transmission. To enhance HIV testing receipt and subsequent treatment uptake in Guangxi, the Chinese Center for Disease Control and Prevention (CDC) executed a cluster-randomized trial to assess the effectiveness and cost-effectiveness of a streamlined HIV testing algorithm (the One4All intervention) in 12 county-level hospitals.ObjectiveTo determine the incremental cost-effectiveness of the One4All intervention delivered at county hospitals in Guangxi, China, compared to the current standard of care (SOC).PerspectiveHealth System.Time Horizon1-, 5-and 25-years.MethodsWe adapted a dynamic, compartmental HIV transmission model to simulate HIV transmission and progression in Guangxi, China and identify the economic impact and health benefits of implementing the One4All intervention in all Guangxi hospitals. The One4All intervention algorithm entails rapid point-of-care HIV screening, CD4 and viral load testing of individuals presenting for HIV screening, with same-day results and linkage to counselling. We populated the model with data from the One4All trial (CTN-0056), China CDC HIV registry and published reports. Model outcomes were HIV incidence, mortality, costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) of the One4All intervention compared to SOC.ResultsThe One4All testing intervention was more costly than SOC (CNY 2,182 vs. CNY 846), but facilitated earlier ART access, resulting in delayed disease progression and mortality. Over a 25-year time horizon, we estimated that introducing One4All in Guangxi would result in 802 averted HIV cases and 1629 averted deaths at an ICER of CNY 11,678 per QALY gained. Sensitivity analysis revealed that One4All remained cost-effective at even minimal levels of effectiveness. Results were robust to changes to a range of parameters characterizing the HIV epidemic over time.ConclusionsThe One4All HIV testing strategy was highly cost-effective by WHO standards, and should be prioritized for widespread implementation in Guangxi, China. Integrating the intervention within a broader combination prevention strategy would enhance the public health response to HIV/AIDS in Guangxi.

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“…The use of ART (antiretroviral therapy) in HIV-infected patients has shown its efficiency not only in improving the individual outcomes of patients but also in reducing the transmission of HIV [ 1 – 3 ]. A persisting challenge of the HIV epidemic is reaching the highest proportion of overall viral suppression among people living with HIV (PLHIV) in order to impact HIV transmission [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Good continuum of HIV care in Belgium despite weaknesses in retention and linkage to care among migrants

et al. 2015

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BackgroundThe Belgian HIV epidemic is largely concentrated among men who have sex with men and Sub-Saharan Africans. We studied the continuum of HIV care of those diagnosed with HIV living in Belgium and its associated factors.MethodsData on new HIV diagnoses 2007–2010 and HIV-infected patients in care in 2010–2011 were analysed. Proportions were estimated for each sequential stage of the continuum of HIV care and factors associated with attrition at each stage were studied.ResultsOf all HIV diagnosed patients living in Belgium in 2011, an estimated 98.2 % were linked to HIV care, 90.8 % were retained in care, 83.3 % received antiretroviral therapy and 69.5 % had an undetectable viral load (<50 copies/ml). After adjustment for sex, age at diagnosis, nationality and mode of transmission, we found lower entry into care in non-Belgians and after preoperative HIV diagnoses; lower retention in non-Belgians and injecting drug users; higher retention in men who have sex with men and among those on ART. Younger patients had lower antiretroviral therapy uptake and less viral suppression; those with longer time from diagnosis had higher ART uptake and more viral suppression; Sub-Saharan Africans on ART had slightly less viral suppression.ConclusionsThe continuum of HIV care in Belgium presents low attrition rates over all stages. The undiagnosed HIV-infected population, although not precisely estimated, but probably close to 20 % based on available survey and surveillance results, could be the weakest stage of the continuum of HIV care. Its identification is a priority along with improving the HIV care continuum of migrants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1230-3) contains supplementary material, which is available to authorized users.

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Cost-effectiveness Analysis Along the Continuum of HIV Care: How Can We Optimize the Effect of HIV Treatment as Prevention Programs?

Cited by 19 publications

References 61 publications

The biopolitics of engagement and the HIV cascade of care: a synthesis of the literature on patient citizenship and antiretroviral therapy

The biopolitics of engagement and the HIV cascade of care: a synthesis of the literature on patient citizenship and antiretroviral therapy

Cost-Effectiveness of the ‘One4All’ HIV Linkage Intervention in Guangxi Zhuang Autonomous Region, China

Good continuum of HIV care in Belgium despite weaknesses in retention and linkage to care among migrants

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