Clinical Impact and Cost-effectiveness of Diagnosing HIV Infection During Early Infancy in South Africa: Test Timing and Frequency
Clinical Impact and Cost-effectiveness of Diagnosing HIV Infection During Early Infancy in South Africa: Test Timing and Frequency
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DOI：
10.1093/infdis/jiw379
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发表时间：
2016-11-01
影响因子：
6.4
通讯作者：
Ciaranello, Andrea
中科院分区：
文献类型：
--
作者：
Francke, Jordan A.;Penazzato, Martina;Ciaranello, Andrea
背景在婴儿早期诊断出人类免疫缺陷病毒（HIV）感染（通常称为“早期婴儿HIV诊断”[EID]），然后立即开始抗逆转录病毒治疗，可显著降低死亡率。EID测试建议在6周大，但许多婴儿infections missed.Design/Methods.aEuro integral我们模拟了4 EID测试策略为艾滋病毒暴露的婴儿在南非：没有EID（仅在患病后诊断;此后，“无EID”），检测一次（仅在出生时或仅在6周龄时;下文分别称为“仅出生”和“仅6周龄”），并测试两次（出生和6周龄时;以下称为“出生和6周龄”）。我们计算了增量成本效益比（ICER），使用贴现成本和所有HIV暴露者的预期寿命。（感染和未感染）婴儿。结果。aEuro积分在基础病例中（指南一致的护理），无EID策略产生的预期寿命为21.1岁（在HIV感染组）和61.1岁（在HIV暴露组）;终生成本平均为1430美元/HIV暴露婴儿。出生和6周策略最大限度地延长了预期寿命（艾滋病毒感染组为26.5岁，艾滋病毒暴露组为61.4岁），每名接受检测的婴儿花费1 840美元。6周单独策略与无EID策略的ICER为1250美元/年挽救生命（南非人均国内生产总值的19%）;出生和6周策略与6周单独策略的ICER为2900美元/年挽救生命（南非人均国内生产总值的45%）。增加比例的照顾者谁收到测试结果和艾滋病毒阳性的婴儿抗逆转录病毒治疗与6周单独的战略提高生存率超过增加第二个test.Conclusions。aEuro积分EID在出生时和6周改善的结果，是具有成本效益的，与EID在6周单独。如果扩大规模的成本是可比的，方案应增加出生测试后，加强6周的测试计划。
Background. Diagnosis of human immunodeficiency virus (HIV) infection during early infancy (commonly known as "early infant HIV diagnosis" [EID]) followed by prompt initiation of antiretroviral therapy dramatically reduces mortality. EID testing is recommended at 6 weeks of age, but many infant infections are missed.Design/Methods.aEuro integral We simulated 4 EID testing strategies for HIV-exposed infants in South Africa: no EID (diagnosis only after illness; hereafter, "no EID"), testing once (at birth alone or at 6 weeks of age alone; hereafter, "birth alone" and "6 weeks alone," respectively), and testing twice (at birth and 6 weeks of age; hereafter "birth and 6 weeks"). We calculated incremental cost-effectiveness ratios (ICERs), using discounted costs and life expectancies for all HIV-exposed (infected and uninfected) infants.Results.aEuro integral In the base case (guideline-concordant care), the no EID strategy produced a life expectancy of 21.1 years (in the HIV-infected group) and 61.1 years (in the HIV-exposed group); lifetime cost averaged $1430/HIV-exposed infant. The birth and 6 weeks strategy maximized life expectancy (26.5 years in the HIV-infected group and 61.4 years in the HIV-exposed group), costing $1840/infant tested. The ICER of the 6 weeks alone strategy versus the no EID strategy was $1250/year of life saved (19% of South Africa's per capita gross domestic product); the ICER for the birth and 6 weeks strategy versus the 6 weeks alone strategy was $2900/year of life saved (45% of South Africa's per capita gross domestic product). Increasing the proportion of caregivers who receive test results and the linkage of HIV-positive infants to antiretroviral therapy with the 6 weeks alone strategy improved survival more than adding a second test.Conclusions.aEuro integral EID at birth and 6 weeks improves outcomes and is cost-effective, compared with EID at 6 weeks alone. If scale-up costs are comparable, programs should add birth testing after strengthening 6-week testing programs.