Optimal timing of HIV home‐based counselling and testing rounds in Western Kenya

Abstract

IntroductionWeaknesses in care programmes providing anti‐retroviral therapy (ART) persist and are often instigated by late HIV diagnosis and poor linkage to care. We investigated the potential for a home‐based counselling and testing (HBCT) campaign to be improved through the optimal timing and enhancement of testing rounds to generate greater health outcomes at minimum cost.MethodsUsing a mathematical model of HIV care calibrated to longitudinal data from The Academic Model Providing Access To Healthcare (AMPATH) in Kenya, we simulated HBCT campaigns between 2016 and 2036, assessing the impact and total cost of care for each, for a further 20 years.ResultsWe find that simulating five equally spaced rounds averts 1.53 million disability‐adjusted life‐years (DALYs) at a cost of $1617 million. By altering the timing of HBCT rounds, a four‐round campaign can produce greater impact for lower cost. With “front‐loaded” rounds, the cost per DALY averted is reduced by 12% as fewer rounds are required ($937 vs. $1060). Furthermore, improvements to HBCT coverage and linkage to care avert over two million DALYs at a cost per DALY averted of $621 (41% less than the reference scenario).ConclusionsCountries implementing HBCT can reduce costs by optimally timing rounds and generate greater health outcomes through improving linkage, coverage, and retention. Tailoring HBCT campaigns to individual settings can enhance patient outcomes for minimal cost.

Questionable assumptions mar modelling of Kenya home‐based testing campaigns

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We appreciate the letter in response to our article "Optimal timing of HIV home-based counselling and testing rounds in Western Kenya [1]. " The authors appraise the assumptions made by the model and question whether the modelled HBCT programme in western Kenya could be improved [2].As the authors are aware, high prevalence settings often require active outreach to identify a meaningful proportion of the infected population [3].

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“…We appreciate the letter in response to our article "Optimal timing of HIV home-based counselling and testing rounds in Western Kenya [1]. " The authors appraise the assumptions made by the model and question whether the modelled HBCT programme in western Kenya could be improved [2].…”

Cost and cost-effectiveness of a universal HIV testing and treatment intervention in Zambia and South Africa: evidence and projections from the HPTN 071 (PopART) trial

“…A modelling study of an HBCT campaign in western Kenya showed that in 20 years, DALYs averted could be maximised with a so-called front-loaded scenario, whereby four testing rounds are delivered in years 1, 2, 4, and 8, compared with a scenario of five equally spaced rounds every 4 years. 42 More research is needed exploring alternative and sustainable approaches to HIV test provision, including initial door-to-door testing followed by mobile or hub-based testing, self-testing, 43 , 44 or potentially decreasing the frequency of door-to-door testing.…”