Cost-effectiveness of a combination strategy to enhance the HIV care continuum in Swaziland: Link4Health.
Cost-effectiveness of a combination strategy to enhance the HIV care continuum in Swaziland: Link4Health.
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DOI：
10.1371/journal.pone.0204245
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Braithwaite RS
中科院分区：
文献类型：
--
作者：
Stevens ER;Li L;Nucifora KA;Zhou Q;McNairy ML;Gachuhi A;Lamb MR;Nuwagaba-Biribonwoha H;Sahabo R;Okello V;El-Sadr WM;Braithwaite RS
Link4Health，一个分组随机对照研究，展示了针对各种艾滋病毒连续体障碍的组合战略的有效性；在与艾滋病毒的联系和保留护理上的步骤；显示了在艾滋病毒携带者在艾滋病毒检测后1个月内实现与艾滋病毒护理的联系以及在艾滋病毒检测后12个月保留护理方面的有效性(RR1.48，95%CI1.19-1.96，p=0.002)。除了标准的护理外，Link4Health还包括：1)护理点CD4+计数测试；2)加速抗逆转录病毒治疗；3)手机预约提醒；4)包括商品和信息材料的护理和预防套餐；以及5)非现金经济奖励。我们的目标是评估在斯威士兰扩大Link4健康战略的成本效益。我们将Link4Health战略的效果和成本纳入了对斯威士兰艾滋病毒流行的计算机模拟，比较了该战略扩大规模的情景与没有实施的情景。该模拟结合了艾滋病毒传播的确定性分隔模型和根据斯威士兰流行病学数据校准的艾滋病毒进展的随机微观模拟。它纳入了下游可能节省的医疗成本，以及通过改善联系和治疗依从性可能防止的感染。我们评估了Link4Health与标准医疗相比的增量成本效益比，从卫生部门的角度，报告了2015美元，时间跨度为20年，贴现率为3%，符合世卫组织的指导方针。我们的结果表明，Link4Health战略的扩大将在20年内将新的艾滋病毒感染减少11,059例，比预计的169,019例减少7%，并防止5,313例死亡，比预计的49,582例减少11%。从卫生部门的角度来看，Link4Health导致每个预防感染的增量成本为13,310美元，每个QALY的增量成本为3,560美元/QALY。使用人均国内生产总值的3倍门槛，Link4 Health战略很可能是应对斯威士兰艾滋病毒流行的一种具有成本效益的战略。
Link4Health, a cluster-RCT, demonstrated the effectiveness of a combination strategy targeting barriers at various HIV continuum steps on linkage to and retention in care; showing effectiveness in achieving linkage to HIV care within 1 month plus retention in care at 12 months after HIV testing for people living with HIV (RR 1.48, 95% CI 1.19–1.96, p = 0.002). In addition to standard of care, Link4Health included: 1) Point-of-care CD4+ count testing; 2) Accelerated ART initiation; 3) Mobile phone appointment reminders; 4) Care and prevention package including commodities and informational materials; and 5) Non-cash financial incentive. Our objective was to evaluate the cost-effectiveness of a scale-up of the Link4Health strategy in Swaziland. We incorporated the effects and costs of the Link4Health strategy into a computer simulation of the HIV epidemic in Swaziland, comparing a scenario where the strategy was scaled up to a scenario with no implementation. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression calibrated to Swaziland epidemiological data. It incorporated downstream health costs potentially saved and infections potentially prevented by improved linkage and treatment adherence. We assessed the incremental cost-effectiveness ratio of Link4Health compared to standard care from a health sector perspective reported in US$2015, a time horizon of 20 years, and a discount rate of 3% in accordance with WHO guidelines. Our results suggest that scale-up of the Link4Health strategy would reduce new HIV infections over 20 years by 11,059 infections, a 7% reduction from the projected 169,019 cases and prevent 5,313 deaths, an 11% reduction from the projected 49,582 deaths. Link4Health resulted in an incremental cost per infection prevented of $13,310 and an incremental cost per QALY gained of $3,560/QALY from the health sector perspective. Using a threshold of <3 x per capita GDP, the Link4Health strategy is likely to be a cost-effective strategy for responding to the HIV epidemic in Swaziland.
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DOI：
10.1111/acer.12332
发表时间：
2014-04
期刊：
Alcoholism, clinical and experimental research
影响因子：
--
作者：
Braithwaite RS;Nucifora KA;Kessler J;Toohey C;Mentor SM;Uhler LM;Roberts MS;Bryant K
通讯作者：
Bryant K
影响因子：
56.3
作者：
Boily, Marie-Claude;Baggaley, Rebecca F.;Wang, Lei;Masse, Benoit;White, Richard G.;Hayes, Richard J.;Alary, Michel
通讯作者：
Alary, Michel
影响因子：
6
作者：
Braithwaite, R. Scott;Nucifora, Kimberly A.;Wools-Kaloustian, Kara
通讯作者：
Wools-Kaloustian, Kara
影响因子：
16.1
作者：
Amanyire, Gideon;Semitala, Fred C.;Geng, Elvin
通讯作者：
Geng, Elvin
影响因子：
4.5
作者：
Braithwaite, R. Scott;Goulet, Joseph;Justice, Amy C.
通讯作者：
Justice, Amy C.