Cost-effectiveness of implementing HIV and HIV/syphilis dual testing among key populations in Viet Nam: a modelling analysis

Abstract

ObjectivesKey populations, including sex workers, men who have sex with men, and people who inject drugs, have a high risk of HIV and sexually transmitted infections. We assessed the health and economic impacts of different HIV and syphilis testing strategies among three key populations in Viet Nam using a dual HIV/syphilis rapid diagnostic test (RDT).SettingWe used the spectrum AIDS impact model to simulate the HIV epidemic in Viet Nam and evaluated five testing scenarios among key populations. We used a 15-year time horizon and a provider perspective for costs.ParticipantsWe simulate the entire population of Viet Nam in the model.InterventionsWe modelled five testing scenarios among key populations: (1) annual testing with an HIV RDT, (2) annual testing with a dual RDT, (3) biannual testing using dual RDT and HIV RDT, (4) biannual testing using HIV RDT and (5) biannual testing using dual RDT.Primary and secondary outcome measuresThe primary outcome is incremental cost-effectiveness ratios. Secondary outcomes include HIV and syphilis cases.ResultsAnnual testing using a dual HIV/syphilis RDT was cost-effective (US$10 per disability-adjusted life year (DALY)) and averted 3206 HIV cases and treated 27 727 syphilis cases compared with baseline over 15 years. Biannual testing using one dual test and one HIV RDT (US$1166 per DALY), or two dual tests (US$5672 per DALY) both averted an additional 875 HIV cases, although only the former scenario was cost-effective. Annual or biannual HIV testing using HIV RDTs and separate syphilis tests were more costly and less effective than using one or two dual RDTs.ConclusionsAnnual HIV and syphilis testing using dual RDT among key populations is cost-effective in Vietnam and similar settings to reach global reduction goals for HIV and syphilis.

Missed opportunities for HIV testing among those who accessed sexually transmitted infection (STI) services, tested for STIs and diagnosed with STIs: a systematic review and meta‐analysis

“…A nurse‐led express “Test and Go” HIV/STI testing service for MSM in Melbourne also effectively reduced consultation costs of seeing these men [ 23 ]. A modelling analysis of implementing HIV/syphilis dual testing among key populations in Vietnam reported that annual or biannual dual testing could be cost‐effective [ 97 ]. Further studies of the cost‐effectiveness of integrating HIV screening with STI testing in a range of settings, especially in low and middle‐income countries, would be helpful to support decision‐making.…”

Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region

“…As of 2023, WHO now recommends dual HIV/syphilis testing for key populations and those with high ongoing HIV risk and this may further increase its use in HIV testing algorithms in national programmes 25. It is an important option to increase HIV and syphilis detection and treatment and a recent modelling study in Viet Nam shows that it is cost-effective and cost saving 26…”

“…25 It is an important option to increase HIV and syphilis detection and treatment and a recent modelling study in Viet Nam shows that it is costeffective and cost saving. 26 As countries update their national HIV testing guidelines to incorporate WHO guidance and adapt their national HIV testing strategies and algorithms to shift towards using three consecutive reactive serology tests to diagnose HIV, introduce dual HIV/syphilis RDTs among pregnant women and key populations, move away from Open access WB, reinforcing retesting prior to ART initiation as well as design flexible algorithms to address kit shortages, WHO encourages national programmes to conduct a verification study to provide objective evidence, before national scale-up, that a specific combination of products work well together without sharing false-reactivity, thus reducing the risk of misdiagnosis. 6 9 To assist countries, WHO has put together a practical toolkit to accelerate policy adoption.…”

Socially Disadvantaged Community Structures and Conditions Negatively Influence Risky Sexual Behavior in Adolescents and Young Adults: A Systematic Review

“…To develop and implement relevant programs and policies, it is important to ascertain the magnitude of changes in the community factors that can produce a relevant social outcome at a reasonable cost. Depending on the financial constraints in the health sector, cost-effectiveness has been used widely to evaluate the costs and health impacts of interventions to optimize resource allocation and maximize the target population’s health [ 60 ]. Based on the findings of the present study, the costs of community-level interventions or individual or family-level interventions with socially disadvantaged populations can be examined.…”

“…Furthermore, their social impacts, including sexual behavior outcomes or health outcomes (e.g., STI, HIV infections, or related deaths) could be used for cost-effective analyses. Cost-effective health interventions for HIV testing [ 60 ] and gonorrhea vaccination [ 61 ] were also examined. The current findings indicate that intervention programs that target adolescents and young adults living in relatively disadvantaged communities need to be developed.…”