Increasing the initiation of antiretroviral therapy through optimal placement of diagnostic technologies for pediatric HIV in Zimbabwe: A modeling analysis.
Increasing the initiation of antiretroviral therapy through optimal placement of diagnostic technologies for pediatric HIV in Zimbabwe: A modeling analysis.
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DOI：
10.1016/j.ijid.2023.05.013
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发表时间：
2023-09
影响因子：
8.4
通讯作者：
Jalali, Mohammad S.
中科院分区：
文献类型：
--
作者：
Yildirim, Melike;Webb, Karen A.;Ciaranello, Andrea L.;Amick, Alyssa K.;Mushavi, Angela;Chimwaza, Anesu;Claypool, Anneke;Murape, Tendayi;McCann, Nicole C.;Flanagan, Clare F.;Jalali, Mohammad S.
用于婴儿艾滋病毒检测的即时护理设备提供了及时的结果反馈，并增加了抗逆转录病毒（ART）的启动。我们的目标是优化POC设备的位置，以增加津巴布韦马塔贝莱兰南部地区30天的抗逆转录病毒治疗起始量。我们开发了一个优化模型，以确定卫生设施中有限的POC设备的位置，最大限度地增加接受艾滋病毒检测结果并在检测后30天内开始抗逆转录病毒治疗的婴儿人数。我们将位置优化模型的结果与非基于模型的决策启发式方法进行了比较，后者更实用，数据密集程度更低。启发式方法根据需求、测试阳性、实验室结果返回概率和POC机器功能分配POC设备。目前放置了11台现有的POC机器，预计所有接受艾滋病毒检测的婴儿中有37%将获得结果，35%预计将在检测后30天内开始抗逆转录病毒治疗。通过优化现有机器的位置，46%的人预计将在30天内收到结果，44%的人将开始抗逆转录病毒治疗，在现有地点保留3台机器，将8台机器移至新设施。基于最高POC设备功能的重新安置将是表现最好的启发式决策（44%收到结果，42%在30天内启动ART）；尽管如此，它仍然不如基于优化的方法执行得好。对有限的POC机器进行优化和临时启发式重新定位将增加及时的结果返回和ART启动，而无需进一步的、通常昂贵的干预。地点优化可以加强有关艾滋病毒护理医疗技术安置的决策。
Point-of-care (POC) devices for infant HIV testing provide timely result-return and increase antiretroviral (ART) initiation. We aimed to optimally locate POC devices to increase 30-day ART initiation in Matabeleland South, Zimbabwe. We developed an optimization model to identify the locations for limited POC devices at health facilities, maximizing the number of infants who receive HIV test results and initiate ART within 30 days of testing. We compared location-optimization model results to non-model-based decision heuristics, which are more practical and less data-intensive. Heuristics assign POC devices based on demand, test positivity, laboratory result-return probability, and POC machine functionality. With the current placement of 11 existing POC machines, 37% of all tested infants with HIV were projected to receive results and 35% were projected to initiate ART within 30 days of testing. With optimal placement of existing machines, 46% were projected to receive results and 44% to initiate ART within 30 days, retaining three machines in current locations, moving eight to new facilities. Relocation based on the highest POC device functionality would be the best-performing heuristic decision (44% receiving results and 42% initiating ART withing 30 days); although, it still would not perform as well as the optimization-based approach. Optimal and ad hoc heuristic relocation of limited POC machines would increase timely result-return and ART initiation, without further, often costly, interventions. Location optimization can enhance decision-making regarding the placement of medical technologies for HIV care.
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