Cost-Effectiveness of Point-of-Care Testing with Task-Shifting for HIV Care in South Africa: A Modelling Study

Mudimu, Edinah; Simeon, Kate; Bershteyn, Anna; Dorward, Jienchi; Violette, Lauren R; Akullian, Adam; Karim, Salim S. Abdool; Celum, Connie; Garrett, Nigel; Drain, Paul K.

doi:10.2139/ssrn.3571531

Cited by 7 publications

(9 citation statements)

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“…Although POC VL testing is more costly than centralized laboratory testing, cost savings to the health system may occur by reducing loss to follow up and increasing ART adherence. Indeed, modeling analyses show that POC testing is projected to reduce HIV-related deaths and HIV transmissions and is cost-effective for monitoring treatment in adults living with HIV in South Africa, particularly in facilities with high levels of virologic failure [ 9 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…POC can enable faster identification of individuals with treatment failure for targeted adherence counseling and/or regimen switching. POC testing has been shown in randomized trials to improve viral suppression and retention in care compared to centralized laboratory testing [ 7 ], and is projected to be cost-effective in other sub-Saharan African settings [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya

et al. 2021

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Background: The number of people living with HIV (PLHIV) in need of treatment monitoring in low-and-middle-income countries is rapidly expanding, straining existing laboratory capacity. Point-of-care viral load (POC VL) testing can alleviate the burden on centralized laboratories and enable faster delivery of results, improving clinical outcomes. However, implementation costs are uncertain and will depend on clinic testing volume. We sought to estimate the costs of decentralized POC VL testing compared to centralized laboratory testing for adults and children receiving HIV care in Kenya. Methods: We conducted microcosting to estimate the per-patient costs of POC VL testing compared to known costs of centralized laboratory testing. We completed time-and-motion observations and stakeholder interviews to assess personnel structures, staff time, equipment costs, and laboratory processes associated with POC VL administration. Capital costs were estimated using a 5 year lifespan and a 3% annual discount rate. Results: We estimated that POC VL testing cost USD $24.25 per test, assuming a clinic is conducting 100 VL tests per month. Test cartridge and laboratory equipment costs accounted for most of the cost (62% and 28%, respectively). Costs varied by number of VL tests conducted at the clinic, ranging from $54.93 to $18.12 per test assuming 20 to 500 VL tests per month, respectively. A VL test processed at a centralized laboratory was estimated to cost USD $25.65. Conclusion: POC VL testing for HIV treatment monitoring can be feasibly implemented in clinics within Kenya and costs declined with higher testing volumes. Our cost estimates are useful to policymakers in planning resource allocation and can inform cost-effectiveness analyses evaluating POC VL testing.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya

et al. 2021

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“…For PLHIV not on ART, risk of HIV-associated death depends on age at time of infection, with older adults progressing more rapidly toward AIDS and death. For PLHIV on ART, risk of HIV-associated death depends on age, sex, and CD4 count at time of ART initiation and level of ART adherence, with declining risk of death on ART for adherent patients who remain stable on ART [13]. For individuals who interrupt and resume ART, risk of death calculated based on CD4 count at time of interruption and re-engagement in ART [14].…”

Section: Hiv Modelsmentioning

confidence: 99%

The Risks and Benefits of Providing HIV Services during the COVID-19 Pandemic

Stover

Kelly

Mudimu

et al. 2021

Preprint

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Introduction The COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services. Methods We used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics. Results Maintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19 - 146 discounted deaths per 10,000 clients. Discussion While there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission.

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“…Nonetheless, task-shared POC testing has been shown to have time-saving benefits for HCWs, improve testing coverage and provide prompt results for expedited patient management [31][32][33], among other benefits. A study of national policies for HIV testing services across 50 countries showed that only 42% allowed LHWs to perform testing using POC tests (64% in African countries), although more allowed LHWs to perform pre-and posttest counseling (56% overall and 80% in Africa) [34].…”

Section: Task Sharing In Healthcare Servicesmentioning

confidence: 99%

Lay testing cadres and point-of-care diagnostic tests for HIV and other diseases: An essential combination in health service delivery

Ndlovu

Ellman

2021

PLoS Med

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Cost-Effectiveness of Point-of-Care Testing with Task-Shifting for HIV Care in South Africa: A Modelling Study

Cited by 7 publications

References 0 publications

Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya

Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya

The Risks and Benefits of Providing HIV Services during the COVID-19 Pandemic

Lay testing cadres and point-of-care diagnostic tests for HIV and other diseases: An essential combination in health service delivery

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