Integrated HIV Testing, Malaria, and Diarrhea Prevention Campaign in Kenya: Modeled Health Impact and Cost-Effectiveness

Kahn, James G.; Muraguri, Nicholas; Harris, Bernard; Lugada, Eric; Clasen, Thomas; Grabowsky, Mark; Mermin, Jonathan; Shariff, Shahnaaz

doi:10.1371/journal.pone.0031316

Cited by 38 publications

(50 citation statements)

References 44 publications

(59 reference statements)

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“…Cost-effectiveness analyses showed that 191 disability-adjusted life years (DALYs) and US$48,123 per 1,000 participants could be averted through the provision of the US$20 water filters to HIV-infected individuals. 33,34 These data also suggest that there may be added benefit of simple home visitations to reinforce the use of the device; however, we do not have estimates on the cost effectiveness of such services. This type of reinforcement is likely cost effective only in settings where participants live within a reasonable distance from health facilities.…”

Section: Discussionmentioning

confidence: 93%

Water Filter Provision and Home-Based Filter Reinforcement Reduce Diarrhea in Kenyan HIV-Infected Adults and Their Household Members

Pavlinac

Naulikha

Chaba

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. Among human immunodeficiency virus (HIV) -infected adults and children in Africa, diarrheal disease remains a major cause of morbidity and mortality. We evaluated the effectiveness of provision and home-based reinforcement of a point-of-use water filtration device to reduce diarrhea among 361 HIV-infected adults in western Kenya by comparing prevalence of self-reported diarrhea before and after these interventions. After provision of the filter, 8.7% of participants reported diarrhea compared with 17.2% in the 3 months before filter provision (odds ratio [OR] = 0.39, 95% confidence interval [95% CI] = 0.23-0.66, P 0.001). The association was similar among 231 participants who were already taking daily cotrimoxazole prophylaxis before being given a filter (OR = 0.47, 95% CI = 0.25-0.88, P = 0.019). Educational reinforcement was also associated with a modest reduction in self-reported diarrhea (OR = 0.50, 95% CI = 0.20-0.99, P = 0.047). Provision and reinforcement of water filters may confer significant benefit in reducing diarrhea among HIV-infected persons, even when cotrimoxazole prophylaxis is already being used.

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Section: Discussionmentioning

confidence: 93%

Water Filter Provision and Home-Based Filter Reinforcement Reduce Diarrhea in Kenyan HIV-Infected Adults and Their Household Members

Pavlinac

Naulikha

Chaba

et al. 2014

The American Society of Tropical Medicine and Hygiene

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“…Details of the model have been published elsewhere 8. The model estimates the health and cost benefits of prevention for malaria, diarrhoea and HIV separately.…”

Section: Methodsmentioning

confidence: 99%

“…Those testing positive for HIV were offered on-site CD4 count determination, cotrimoxazole prophylaxis and referral to comprehensive HIV care and treatment. The campaign yielded large health benefits and net economic savings 7 8. Large-scale expansion of this integrated prevention campaign (IPC) has the potential to deliver substantial health benefits and cost savings.…”

Section: Introductionmentioning

confidence: 99%

Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries

Marseille¹,

Jiwani

Raut

et al. 2014

BMJ Open

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ObjectiveThis study estimated the health impact, cost and cost-effectiveness of an integrated prevention campaign (IPC) focused on diarrhoea, malaria and HIV in 70 countries ranked by per capita disability-adjusted life-year (DALY) burden for the three diseases.MethodsWe constructed a deterministic cost-effectiveness model portraying an IPC combining counselling and testing, cotrimoxazole prophylaxis, referral to treatment and condom distribution for HIV prevention; bed nets for malaria prevention; and provision of household water filters for diarrhoea prevention. We developed a mix of empirical and modelled cost and health impact estimates applied to all 70 countries. One-way, multiway and scenario sensitivity analyses were conducted to document the strength of our findings. We used a healthcare payer's perspective, discounted costs and DALYs at 3% per year and denominated cost in 2012 US dollars.Primary and secondary outcomesThe primary outcome was cost-effectiveness expressed as net cost per DALY averted. Other outcomes included cost of the IPC; net IPC costs adjusted for averted and additional medical costs and DALYs averted.ResultsImplementation of the IPC in the 10 most cost-effective countries at 15% population coverage would cost US$583 million over 3 years (adjusted costs of US$398 million), averting 8.0 million DALYs. Extending IPC programmes to all 70 of the identified high-burden countries at 15% coverage would cost an adjusted US$51.3 billion and avert 78.7 million DALYs. Incremental cost-effectiveness ranged from US$49 per DALY averted for the 10 countries with the most favourable cost-effectiveness to US$119, US$181, US$335, US$1692 and US$8340 per DALY averted as each successive group of 10 countries is added ordered by decreasing cost-effectiveness.ConclusionsIPC appears cost-effective in many settings, and has the potential to substantially reduce the burden of disease in resource-poor countries. This study increases confidence that IPC can be an important new approach for enhancing global health.

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“…Findings were robust to the sensitivity analyses performed. Kahn et al 37 concluded a more “favorable outcome” in their study, compared with the CE of existing published findings regarding malaria prevention–related interventions (a cost ranging from $2 to 15 per DALY averted 44 ).…”

Section: Resultsmentioning

confidence: 84%

“…Kahn et al 37 (2012), a level 1–rated study, addressed the CE of the aforementioned “Integrated Prevention Campaign” using a “spreadsheet-based model.” Existing data regarding the impact of the each of the 3 assessed interventions (VCT, LLINs, and water filters) on morbidity and mortality, along with the available costing information from the same campaign (in the study of Kahn et al 2011), were used to determine estimates of averted deaths, DALYs, and cost savings. The model-based analysis included added costs associated with potential earlier ART initiation as well.…”

Section: Resultsmentioning

confidence: 99%

Impact of Cotrimoxazole and Insecticide-Treated Nets for Malaria Prevention on Key Outcomes Among HIV-Infected Adults in Low- and Middle-Income Countries

Hassani

Marston

2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background HIV-infected adults are at increased risk of severe malaria and death. Malaria prevention in people living with HIV (PLHIV) consists of several interventions, including cotrimoxazole (CTX) prophylaxis and insecticide-treated nets (ITNs). We conducted a systematic review of the available evidence. Methods MEDLINE, EmBase, Global Health, CINAHL, SOCA, and African Index Medicus were used to identify articles relevant to the CTX prophylaxis and ITNs interventions from 1995 to July 2014. For each individual study, we assessed the quality of evidence and the impact of the 2 interventions on the outcomes of mortality, morbidity, retention in care, quality of life, and/or prevention of ongoing HIV transmission. For each outcome, we summarized the quality of the overall body of evidence, the expected impact, and costing and cost-effectiveness (CE). Findings The overall quality of evidence regarding malaria-related morbidity was rated as “good” for CTX prophylaxis and “fair” for ITN use; the expected “impact” of these interventions on morbidity was rated “high” and “uncertain,” respectively. Three studies that addressed the costing and CE of ITN provision for malaria prevention in PLHIV consisted of 2 full “level 1” and 1 partial “level 2” economic evaluations. Conclusions CTX prophylaxis is effective in reducing malaria-related morbidity among PLHIV. Limited evidence is available with respect to the impact and the CE of ITN use and/or provision in this population.

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Integrated HIV Testing, Malaria, and Diarrhea Prevention Campaign in Kenya: Modeled Health Impact and Cost-Effectiveness

Cited by 38 publications

References 44 publications

Water Filter Provision and Home-Based Filter Reinforcement Reduce Diarrhea in Kenyan HIV-Infected Adults and Their Household Members

Water Filter Provision and Home-Based Filter Reinforcement Reduce Diarrhea in Kenyan HIV-Infected Adults and Their Household Members

Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries

Impact of Cotrimoxazole and Insecticide-Treated Nets for Malaria Prevention on Key Outcomes Among HIV-Infected Adults in Low- and Middle-Income Countries

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