Optimizing infant HIV diagnosis with additional screening at immunization clinics in three sub-Saharan African settings: a cost-effectiveness analysis.
Optimizing infant HIV diagnosis with additional screening at immunization clinics in three sub-Saharan African settings: a cost-effectiveness analysis.
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DOI：
10.1002/jia2.25651
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发表时间：
2021-01
影响因子：
6
通讯作者：
Ciaranello AL
中科院分区：
文献类型：
--
作者：
Dunning L;Gandhi AR;Penazzato M;Soeteman DI;Revill P;Frank S;Phillips A;Dugdale C;Abrams E;Weinstein MC;Newell ML;Collins IJ;Doherty M;Vojnov L;Fassinou Ekouévi P;Myer L;Mushavi A;Freedberg KA;Ciaranello AL
婴儿早期艾滋病毒诊断（EID）的吸收在撒哈拉以南非洲地区差异很大。我们评估了在婴儿免疫接种访视时进行普遍孕产妇艾滋病毒筛查的潜在临床影响和成本效益，并将其转介到EID和孕产妇抗逆转录病毒治疗（ART）开始。使用CEPAC-儿科模型，我们比较了2017年在科特迪瓦（CI），南非（SA）和津巴布韦出生的婴儿的两种策略：（1）现有的EID计划为已知艾滋病毒暴露（EID）的婴儿提供为期六周的核酸检测（NAT），以及（2）EID加上六周婴儿免疫接种访视时的普遍孕产妇艾滋病毒筛查，导致转诊婴儿NAT和母亲ART启动（筛选和测试）。模型输入包括已公布的科特迪瓦/南非/津巴布韦数据：孕产妇艾滋病毒感染率（4.8/30.8/16.1%），目前接受EID（40/95/65%）和六周免疫接种率（99/74/94%）。筛查和检测后婴儿NAT和母亲ART启动的转诊率为80%。费用包括NAT（24美元/婴儿），孕产妇筛查（10美元/母婴对），抗逆转录病毒治疗（5至31美元/月）和艾滋病毒护理（15至190美元/月）。模型结果包括艾滋病毒暴露婴儿的母婴传播艾滋病毒（MTCT），以及艾滋病毒感染儿童（CWH）和2017年出生的所有儿童的预期寿命（LE）和人均寿命成本。我们使用贴现（3%/年）终身成本和所有儿童的LE计算增量成本效益比（ICER）。我们考虑了每个国家的两个成本效益阈值：（1）每挽救生命年（YLS）的人均GDP（1720/6380/2150美元），以及（2）CEPAC生成的提供2个与1个终身ART方案的ICER（例如提供二线ART; 520/500/580美元/YLS）。对于EID，预计6周MTCT为9.3%（CI），4.2%（SA）和5.2%（津巴布韦）。筛查和检测使总的母婴传播减少了0.2%至0.5%，使CWH的LE延长了2.0至3.5年，使所有儿童的LE延长了0.03至0.07年，并使折扣成本增加了17美元至22美元/儿童（所有儿童）。与EID相比，筛查和检测的ICER为1340美元/年LS（CI），650美元/年LS（SA）和670美元/年LS（津巴布韦），低于人均GDP，但高于所有国家2对1终身ART方案的ICER。在免疫接种访视时进行普遍的孕产妇艾滋病毒筛查，并转诊到EID和孕产妇ART启动，可以减少母婴传播，改善儿科LE，并与目前在南非和津巴布韦等孕产妇艾滋病毒高流行环境中的艾滋病毒相关干预措施具有可比价值。
Uptake of early infant HIV diagnosis (EID) varies widely across sub‐Saharan African settings. We evaluated the potential clinical impact and cost‐effectiveness of universal maternal HIV screening at infant immunization visits, with referral to EID and maternal antiretroviral therapy (ART) initiation. Using the CEPAC‐Pediatric model, we compared two strategies for infants born in 2017 in Côte d’Ivoire (CI), South Africa (SA), and Zimbabwe: (1) existing EID programmes offering six‐week nucleic acid testing (NAT) for infants with known HIV exposure (EID), and (2) EID plus universal maternal HIV screening at six‐week infant immunization visits, leading to referral for infant NAT and maternal ART initiation (screen‐and‐test). Model inputs included published Ivoirian/South African/Zimbabwean data: maternal HIV prevalence (4.8/30.8/16.1%), current uptake of EID (40/95/65%) and six‐week immunization attendance (99/74/94%). Referral rates for infant NAT and maternal ART initiation after screen‐and‐test were 80%. Costs included NAT ($24/infant), maternal screening ($10/mother–infant pair), ART ($5 to 31/month) and HIV care ($15 to 190/month). Model outcomes included mother‐to‐child transmission of HIV (MTCT) among HIV‐exposed infants, and life expectancy (LE) and mean lifetime per‐person costs for children with HIV (CWH) and all children born in 2017. We calculated incremental cost‐effectiveness ratios (ICERs) using discounted (3%/year) lifetime costs and LE for all children. We considered two cost‐effectiveness thresholds in each country: (1) the per‐capita GDP ($1720/6380/2150) per year‐of‐life saved (YLS), and (2) the CEPAC‐generated ICER of offering 2 versus 1 lifetime ART regimens (e.g. offering second‐line ART; $520/500/580/YLS). With EID, projected six‐week MTCT was 9.3% (CI), 4.2% (SA) and 5.2% (Zimbabwe). Screen‐and‐test decreased total MTCT by 0.2% to 0.5%, improved LE by 2.0 to 3.5 years for CWH and 0.03 to 0.07 years for all children, and increased discounted costs by $17 to 22/child (all children). The ICER of screen‐and‐test compared to EID was $1340/YLS (CI), $650/YLS (SA) and $670/YLS (Zimbabwe), below the per‐capita GDP but above the ICER of 2 versus 1 lifetime ART regimens in all countries. Universal maternal HIV screening at immunization visits with referral to EID and maternal ART initiation may reduce MTCT, improve paediatric LE, and be of comparable value to current HIV‐related interventions in high maternal HIV prevalence settings like SA and Zimbabwe.
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DOI：
10.1056/nejmoa0911486
发表时间：
2010-06-17
期刊：
The New England journal of medicine
影响因子：
--
作者：
Chasela CS;Hudgens MG;Jamieson DJ;Kayira D;Hosseinipour MC;Kourtis AP;Martinson F;Tegha G;Knight RJ;Ahmed YI;Kamwendo DD;Hoffman IF;Ellington SR;Kacheche Z;Soko A;Wiener JB;Fiscus SA;Kazembe P;Mofolo IA;Chigwenembe M;Sichali DS;van der Horst CM;BAN Study Group
通讯作者：
BAN Study Group
影响因子：
9.3
作者：
Ciaranello AL;Park JE;Ramirez-Avila L;Freedberg KA;Walensky RP;Leroy V
通讯作者：
Leroy V
影响因子：
2.8
作者：
Doherty K;Essajee S;Penazzato M;Holmes C;Resch S;Ciaranello A
通讯作者：
Ciaranello A
影响因子：
3.6
作者：
Briggs, Andrew H.;Weinstein, Milton C.;Paltiel, A. David
通讯作者：
Paltiel, A. David
影响因子：
6
作者：
Cambiano, Valentina;Johnson, Cheryl C.;Phillips, Andrew
通讯作者：
Phillips, Andrew