The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis
The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis
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DOI：
10.1002/jia2.25243
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发表时间：
2019-03-01
影响因子：
6
通讯作者：
Phillips, Andrew
中科院分区：
文献类型：
--
作者：
Cambiano, Valentina;Johnson, Cheryl C.;Phillips, Andrew
在非洲，未确诊艾滋病毒的流行率正在下降，各种艾滋病毒检测方法发现阳性率较低。在这种情况下，基于社区的艾滋病毒自我检测（CB-HIVST）的流行病学影响和成本效益尚不清楚。我们的目的是评估这一点，在不同的亚群和跨场景的特点是不同的成人艾滋病毒感染率和抗逆转录病毒治疗方案在撒哈拉以南African.MethodsThe综合模型被用来解决这个目标。CB-HIVST考虑了三个亚群：（i）有性交易的女性（WTS）;（ii）年轻人（15至24岁）;（iii）成年男性（25至49岁）。我们假设CB-HIVST的摄入量与流行病学研究中报告的相似（基础病例），或者假设人们仅在自上次HIV检测以来暴露于风险（无避孕套性行为）时使用CB-HIVST。我们还考虑了一个为期五年的有时限的CB-HIVST方案。成本效益的定义是在50年的时间范围内，增量成本效益比（ICER;避免的每残疾调整生命年成本）低于500美元。有针对性的CB-HIVST的效率进行了评估，使用额外的测试每感染或死亡averted.ResultsIn的基础情况下，针对成年男子与CB-HIVST提供了最大的影响，避免1500艾滋病毒感染和520例死亡，每年在一个模拟的国家与900万成年人的背景下，和影响可以加强联系自愿医疗男性包皮环切术（VMMC）。然而，只有当该方案限于五年或未确诊的患病率高于3%时，这种方法才具有成本效益。CB-HIVST到WTS是最具成本效益的。成本效益的主要驱动因素是CB-HIVST的成本和未确诊艾滋病毒的流行率。所有其他CB-HIVST方案的ICER超过US$500每DALYaverted.ConclusionsCB-HIVST表现出重要的流行病学影响。为了在固定预算内最大限度地提高人口健康，CB-HIVST需要根据未确诊艾滋病毒的流行率、亚人群和提供这种检测模式的总体成本来确定目标。与VMMC挂钩可提高其成本效益。
IntroductionThe prevalence of undiagnosed HIV is declining in Africa, and various HIV testing approaches are finding lower positivity rates. In this context, the epidemiological impact and cost-effectiveness of community-based HIV self-testing (CB-HIVST) is unclear. We aimed to assess this in different sub-populations and across scenarios characterized by different adult HIV prevalence and antiretroviral treatment programmes in sub-Saharan Africa.MethodsThe synthesis model was used to address this aim. Three sub-populations were considered for CB-HIVST: (i) women having transactional sex (WTS); (ii) young people (15 to 24years); and (iii) adult men (25 to 49years). We assumed uptake of CB-HIVST similar to that reported in epidemiological studies (base case), or assumed people use CB-HIVST only if exposed to risk (condomless sex) since last HIV test. We also considered a five-year time-limited CB-HIVST programme. Cost-effectiveness was defined by an incremental cost-effectiveness ratio (ICER; cost-per-disability-adjusted life-year (DALY) averted) below US$500 over a time horizon of 50years. The efficiency of targeted CB-HIVST was evaluated using the number of additional tests per infection or death averted.ResultsIn the base case, targeting adult men with CB-HIVST offered the greatest impact, averting 1500 HIV infections and 520 deaths per year in the context of a simulated country with nine million adults, and impact could be enhanced by linkage to voluntary medical male circumcision (VMMC). However, the approach was only cost-effective if the programme was limited to five years or the undiagnosed prevalence was above 3%. CB-HIVST to WTS was the most cost-effective. The main drivers of cost-effectiveness were the cost of CB-HIVST and the prevalence of undiagnosed HIV. All other CB-HIVST scenarios had an ICER above US$500 per DALY averted.ConclusionsCB-HIVST showed an important epidemiological impact. To maximize population health within a fixed budget, CB-HIVST needs to be targeted on the basis of the prevalence of undiagnosed HIV, sub-population and the overall costs of delivering this testing modality. Linkage to VMMC enhances its cost-effectiveness.