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A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa.

Publication ,  Journal Article
Waters, RC; Ostermann, J; Reeves, TD; Masnick, MF; Thielman, NM; Bartlett, JA; Crump, JA
Published in: J Acquir Immune Defic Syndr
April 15, 2011

BACKGROUND: Guidelines in sub-Saharan Africa on when HIV-seronegative persons should retest range from never to annually for lower-risk populations and from annually to every 3 months for high-risk populations. METHODS: We designed a mathematical model to compare the cost-effectiveness of alternative HIV retesting frequencies. Cost of HIV counseling and testing, linkage to care, treatment costs, disease progression, and mortality, and HIV transmission are modeled for three hypothetical cohorts with posited annual HIV incidence of 0.8%, 1.3%, and 4.0%, respectively. The model compared costs, quality-adjusted life-years gained, and secondary infections averted from testing intervals ranging from 3 months to 30 years. Input parameters from sub-Saharan Africa were used and explored in sensitivity analyses. RESULTS: Accounting for secondary infections averted, the most cost-effective testing frequency was every 7.5 years for 0.8% incidence, every 5 years for 1.3% incidence, and every 2 years for 4.0% incidence. Optimal testing strategies and their relative cost-effectiveness were most sensitive to assumptions about HIV counseling and testing and treatment costs, rates of CD4 decline, rates of HIV transmission, and whether tertiary infections averted were taken into account. CONCLUSIONS: While higher risk populations merit more frequent HIV testing than low risk populations, regular retesting is beneficial even in low-risk populations. Our data demonstrate benefits of tailoring testing intervals to resource constraints and local HIV incidence rates.

Duke Scholars

Published In

J Acquir Immune Defic Syndr

DOI

EISSN

1944-7884

Publication Date

April 15, 2011

Volume

56

Issue

5

Start / End Page

443 / 452

Location

United States

Related Subject Headings

  • Young Adult
  • Virology
  • Sensitivity and Specificity
  • Quality-Adjusted Life Years
  • Pregnancy
  • Models, Economic
  • Male
  • Incidence
  • Humans
  • Health Care Costs
 

Citation

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Waters, R. C., Ostermann, J., Reeves, T. D., Masnick, M. F., Thielman, N. M., Bartlett, J. A., & Crump, J. A. (2011). A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa. J Acquir Immune Defic Syndr, 56(5), 443–452. https://doi.org/10.1097/QAI.0b013e3182118f8c
Waters, Richard C., Jan Ostermann, Travis D. Reeves, Max F. Masnick, Nathan M. Thielman, John A. Bartlett, and John A. Crump. “A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa.J Acquir Immune Defic Syndr 56, no. 5 (April 15, 2011): 443–52. https://doi.org/10.1097/QAI.0b013e3182118f8c.
Waters RC, Ostermann J, Reeves TD, Masnick MF, Thielman NM, Bartlett JA, et al. A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa. J Acquir Immune Defic Syndr. 2011 Apr 15;56(5):443–52.
Waters, Richard C., et al. “A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa.J Acquir Immune Defic Syndr, vol. 56, no. 5, Apr. 2011, pp. 443–52. Pubmed, doi:10.1097/QAI.0b013e3182118f8c.
Waters RC, Ostermann J, Reeves TD, Masnick MF, Thielman NM, Bartlett JA, Crump JA. A cost-effectiveness analysis of alternative HIV retesting strategies in sub-saharan Africa. J Acquir Immune Defic Syndr. 2011 Apr 15;56(5):443–452.

Published In

J Acquir Immune Defic Syndr

DOI

EISSN

1944-7884

Publication Date

April 15, 2011

Volume

56

Issue

5

Start / End Page

443 / 452

Location

United States

Related Subject Headings

  • Young Adult
  • Virology
  • Sensitivity and Specificity
  • Quality-Adjusted Life Years
  • Pregnancy
  • Models, Economic
  • Male
  • Incidence
  • Humans
  • Health Care Costs