Changing HIV treatment eligibility under health system constraints in sub-Saharan Africa: investment needs, population health gains, and cost-effectiveness.
Changing HIV treatment eligibility under health system constraints in sub-Saharan Africa: investment needs, population health gains, and cost-effectiveness.
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在撒哈拉以南非洲的卫生系统限制下改变艾滋病毒治疗资格：投资需求，人口健康增长和成本效益。
DOI：
10.1097/qad.0000000000001190
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发表时间：
2016-09-24
期刊：
影响因子：
--
通讯作者：
Atun R
中科院分区：
文献类型：
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作者：
Hontelez JA;Chang AY;Ogbuoji O;de Vlas SJ;Bärnighausen T;Atun R
补充数字内容可在正文中获得我们估计了在撒哈拉以南非洲目前占所有艾滋病毒携带者80%的10个国家(埃塞俄比亚、肯尼亚、马拉维、莫桑比克、尼日利亚、南非、坦桑尼亚、乌干达、赞比亚和津巴布韦)扩大艾滋病毒预防和治疗的不同政策选择的投资需求、人口健康收益和成本效益。我们采用了已建立的STDSIM模型来捕捉卫生系统的动态：提供抗逆转录病毒治疗(ART)的需求方和供应方的限制。我们比较了供给侧(即卫生系统能力)和需求侧(即健康寻求行为)限制的不同情景，并确定了在这些限制范围内改变指南对任何CD4+细胞计数的抗逆转录病毒治疗资格的影响。到2050年，继续扩大目前的规模将需要1780亿美元。在模型中测试的所有约束条件下，改变任何CD4+细胞计数的抗逆转录病毒治疗指南都是具有成本效益的，特别是在需求侧受限的卫生系统中，因为更早的启动防止了尚不符合条件的患者失去随访。在当前需求方面的限制下改变指导方针将避免180万人感染，每挽救一个生命年可节省208美元。即使在卫生系统的限制下，任何CD4+细胞计数的治疗资格都将是具有成本效益的。通过改变需求方受限系统中的指南，可以避免不符合治疗条件的患者的过度随访损失和死亡率。今后35年维持撒哈拉以南非洲艾滋病防治工作的财政义务是巨大的，需要政策制定者和捐助者作出强有力的长期承诺，继续划拨其预算的很大一部分。
Supplemental Digital Content is available in the text We estimated the investment needs, population health gains, and cost-effectiveness of different policy options for scaling-up prevention and treatment of HIV in the 10 countries that currently comprise 80% of all people living with HIV in sub-Saharan Africa (Ethiopia, Kenya, Malawi, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe). We adapted the established STDSIM model to capture the health system dynamics: demand-side and supply-side constraints in the delivery of antiretroviral treatment (ART). We compared different scenarios of supply-side (i.e. health system capacity) and demand-side (i.e. health seeking behavior) constraints, and determined the impact of changing guidelines to ART eligibility at any CD4+ cell count within these constraints. Continuing current scale-up would require US$178 billion by 2050. Changing guidelines to ART at any CD4+ cell count is cost-effective under all constraints tested in the model, especially in demand-side constrained health systems because earlier initiation prevents loss-to-follow-up of patients not yet eligible. Changing guidelines under current demand-side constraints would avert 1.8 million infections at US$208 per life-year saved. Treatment eligibility at any CD4+ cell count would be cost-effective, even under health system constraints. Excessive loss-to-follow-up and mortality in patients not eligible for treatment can be avoided by changing guidelines in demand-side constrained systems. The financial obligation for sustaining the AIDS response in sub-Saharan Africa over the next 35 years is substantial and requires strong, long-term commitment of policy-makers and donors to continue to allocate substantial parts of their budgets.