Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania
Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania
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DOI：
10.1016/s0140-6736(00)02447-8
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发表时间：
2000-07-08
期刊：
影响因子：
168.9
通讯作者：
Coates, T
中科院分区：
文献类型：
--
作者：
Sweat, M;Gregorich, S;Coates, T
在欠发达国家，获得1型艾滋病毒自愿咨询和检测（VCT）的机会严重有限。我们进行了HIV-1 VCT的多地点试验，以评估其在欠发达国家环境中的影响、成本和成本效益。方法对东非城市1万名寻求VCT的假设队列进行HIV-1 VCT的成本效益评估。结果是基于坦桑尼亚和肯尼亚HIV-1 VCT随机对照试验的结果建模的。我们的主要结局指标包括项目成本、避免HIV-1感染的数量、避免每个HIV-1感染的成本和节省的每个残疾调整生命年（DALY）的成本。我们还模拟了针对VCT的影响，包括客户群体中HIV-1的患病率，以及夫妻接受VCT的客户比例与个人接受VCT的比例。对所有模型参数进行敏感性分析。HIV-1 VCT估计在随后的一年中在肯尼亚避免了1104例HIV-1感染，在坦桑尼亚避免了895例HIV-1感染，避免每例HIV-1感染的成本分别为249美元和346美元，每个DALY节省的成本分别为12.77美元和17.78美元。这种干预措施对hiv -1感染者和作为夫妇接受VCT的人来说是最具成本效益的。VCT的成本效益很强，在肯尼亚，每个DALY的平均成本节省了5.16-27.36美元，在坦桑尼亚为6.58-45.03美元。对目标的分析表明，将夫妇比例提高到70%，可将节省的每个DALY成本降低到肯尼亚的10.71美元和坦桑尼亚的13.39美元，将艾滋病毒-1患病率为45%的人群作为目标，可将节省的每个DALY成本降低到肯尼亚的8.36美元和坦桑尼亚的11.74美元。HIV-1 VCT在东非城市环境中具有很高的成本效益，但与改善性传播疾病服务和向高流行环境中的孕妇普遍提供奈韦拉平等干预措施相比，成本效益略低。随着VCT的目标人群是HIV-1高患病率人群和夫妇，VCT的成本效益得到了显著提高。
Background Access to HIV-1 voluntary counselling and testing (VCT) is severely limited in less-developed countries. We undertook a multisite trial of HIV-1 VCT to assess its impact, cost, and cost-effectiveness in less-developed country settings.Methods The cost-effectiveness of HIV-1 VCT was estimated for a hypothetical cohort of 10 000 people seeking VCT in urban east Africa. Outcomes were modelled based on results from a randomised controlled trial of HIV-1 VCT in Tanzania and Kenya. Our main outcome measures included programme cost, number of HIV-1 infections averted, cost per HIV-1 infection averted, and cost per disability-adjusted life-year (DALY) saved. We also modelled the impact of targeting VCT by HIV-1 prevalence of the client population, and the proportion of clients who receive VCT as a couple compared with as individuals. Sensitivity analysis was done on all model parameters.Findings HIV-1 VCT was estimated to avert 1104 HIV-1 infections in Kenya and 895 in Tanzania during the subsequent year, The cost per HIV-1 infection averted was US$249 and $346, respectively, and the cost per DALY saved was $12.77 and $17.78. The intervention was most cost-effective for HIV-1-infected people and those who received VCT as a couple. The cost-effectiveness of VCT was robust, with a range for the average cost per DALY saved of $5.16-27.36 in Kenya, and $6.58-45.03 in Tanzania. Analysis of targeting showed that increasing the proportion of couples to 70% reduces the cost per DALY saved to $10.71 in Kenya and $13.39 in Tanzania, and that targeting a population with HIV-1 prevalence of 45% decreased the cost per DALY saved to $8.36 in Kenya and $11.74 in Tanzania.Interpretation HIV-1 VCT is highly cost-effective in urban east African settings, but slightly less so than interventions such as improvement of sexually transmitted disease services and universal provision of nevirapine to pregnant women in high-prevalence settings. With the targeting of VCT to populations with high HIV-1 prevalence and couples the cost-effectiveness of VCT is improved significantly.