Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa
Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa
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DOI：
10.1371/journal.pone.0158303
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发表时间：
2016-07-08
期刊：
影响因子：
3.7
通讯作者：
Cori, Anne
中科院分区：
文献类型：
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作者：
Heffernan, Alastair;Barber, Ella;Cori, Anne
快速诊断工具已被证明可以改善患者与护理之间的联系。在传染病方面，评估这类工具在人口层面的影响和成本效益，包括直接和间接影响，是了解采用这些工具的关键。护理点(POC)的CD4检测已被证明在增加HIV阳性患者开始抗逆转录病毒治疗的比例方面非常有效。我们使用根据南非艾滋病毒流行校准的艾滋病毒传播的动态分区模型，在一系列护理背景下，评估在南非人口水平引入POC CD4检测的影响和成本效益。我们进行了一项荟萃分析，以量化POC和实验室CD4测试之间在CD4测试后与护理相关的比例上的差异。估计了一年和三年期间的累计避免感染和增量成本-效果比(ICER)。我们估计，在当前南非护理背景下引入的POC CD4检测可以在一年内预防1.7%(95%可信区间：0.4%-4.3%)的新艾滋病毒感染。在这种情况下，POC CD4测试在一年后的成本效益为99.8%，估计ICER中值为4,468美元/DALY避免。在扩大艾滋病毒检测和改善护理保留率的医疗保健环境中，POC CD4检测仅在3年后才变得具有成本效益。此外，在不考虑CD4计数的情况下提供抗逆转录病毒治疗，以及使用CD4测试进行临床评估，结果是相似的。我们的发现表明，即使抗逆转录病毒治疗扩大到所有艾滋病毒阳性患者，并在不久的将来加强艾滋病毒检测工作，POC CD4检测仍然是一种成本效益高的工具，即使在短时间内也是如此。我们的研究还说明了评估这种诊断技术在人口层面的潜在影响的重要性，以便将间接收益和成本纳入成本效益的估计。
Rapid diagnostic tools have been shown to improve linkage of patients to care. In the context of infectious diseases, assessing the impact and cost-effectiveness of such tools at the population level, accounting for both direct and indirect effects, is key to informing adoption of these tools. Point-of-care (POC) CD4 testing has been shown to be highly effective in increasing the proportion of HIV positive patients who initiate ART. We assess the impact and cost-effectiveness of introducing POC CD4 testing at the population level in South Africa in a range of care contexts, using a dynamic compartmental model of HIV transmission, calibrated to the South African HIV epidemic. We performed a meta-analysis to quantify the differences between POC and laboratory CD4 testing on the proportion linking to care following CD4 testing. Cumulative infections averted and incremental cost-effectiveness ratios (ICERs) were estimated over one and three years. We estimated that POC CD4 testing introduced in the current South African care context can prevent 1.7% (95% CI: 0.4% - 4.3%) of new HIV infections over 1 year. In that context, POC CD4 testing was cost-effective 99.8% of the time after 1 year with a median estimated ICER of US$4,468/DALY averted. In healthcare contexts with expanded HIV testing and improved retention in care, POC CD4 testing only became cost-effective after 3 years. The results were similar when, in addition, ART was offered irrespective of CD4 count, and CD4 testing was used for clinical assessment. Our findings suggest that even if ART is expanded to all HIV positive individuals and HIV testing efforts are increased in the near future, POC CD4 testing is a cost-effective tool, even within a short time horizon. Our study also illustrates the importance of evaluating the potential impact of such diagnostic technologies at the population level, so that indirect benefits and costs can be incorporated into estimations of cost-effectiveness.