Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya
Background: Despite high efficacy of oral antiretroviral therapy (ART), viral suppression among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA) remains low. Compared to daily oral ART, bimonthly long-acting injectable ART (LA-ART) may simplify adherence, improve clinic...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-08-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537020301978 |
| _version_ | 1818551638996025344 |
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| author | Jessica Culhane Monisha Sharma Kate Wilson D.Allen Roberts Cyrus Mugo Dalton Wamalwa Irene Inwani Ruanne V. Barnabas Pamela K. Kohler |
| author_facet | Jessica Culhane Monisha Sharma Kate Wilson D.Allen Roberts Cyrus Mugo Dalton Wamalwa Irene Inwani Ruanne V. Barnabas Pamela K. Kohler |
| author_sort | Jessica Culhane |
| collection | DOAJ |
| description | Background: Despite high efficacy of oral antiretroviral therapy (ART), viral suppression among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA) remains low. Compared to daily oral ART, bimonthly long-acting injectable ART (LA-ART) may simplify adherence, improve clinical outcomes, and decrease HIV transmission in this priority population. However, LA-ART will likely cost more than oral ART and the cost threshold at which LA-ART will be cost effective in SSA has not been evaluated. Methods: We adapted a mathematical model of HIV transmission and progression in Kenya to include HIV acquisition and viral suppression among AYA (age 10–24). We projected the population-level health and economic impact of providing LA-ART to AYA over a 10-year time horizon assuming oral ART costs of US$233 annually and a two-month duration of viral suppression per LA-ART injection. We calculated the maximum cost at which switching from oral to LA-ART would be considered cost-effective, using thresholds of $500 and $1,508 per disability-adjusted life year averted (WHO's threshold of HIV treatment interventions and Kenya's gross domestic product per capita). Findings: Assuming 85% of AYA switch from oral to injectable formulations, LA-ART is estimated to prevent 40,540 infections and 20,480 deaths over 10 years. The maximum increase in the annual per-person cost of receiving LA-ART is estimated to be $89 and $236 for LA-ART to be cost-effective under the thresholds of $500 and $1,508 per DALY averted, respectively. The cost threshold was lower when non-adherent oral ART AYA users were assumed to be less likely to switch to LA-ART. Interpretation: Providing LA-ART to AYA can be cost-effective in Kenya if it is less than twice the cost of oral ART. Long-acting injectable ART for priority populations with low viral suppression has the potential to cost-effectively avert disability and death. Funding: National Institutes of Health (R01 HD085807; PI: Kohler) |
| first_indexed | 2024-12-12T09:02:34Z |
| format | Article |
| id | doaj.art-3cfdc6333e83472dbe3ee32cc4c5f8a2 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-12-12T09:02:34Z |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-3cfdc6333e83472dbe3ee32cc4c5f8a22022-12-22T00:29:46ZengElsevierEClinicalMedicine2589-53702020-08-0125100453Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in KenyaJessica Culhane0Monisha Sharma1Kate Wilson2D.Allen Roberts3Cyrus Mugo4Dalton Wamalwa5Irene Inwani6Ruanne V. Barnabas7Pamela K. Kohler8Department of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United States; Corresponding author.Department of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United StatesDepartment of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United StatesDepartment of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United StatesUniversity of Nairobi, Nairobi, KenyaUniversity of Nairobi, Nairobi, KenyaKenyatta National Hospital, Nairobi, KenyaDepartment of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United StatesDepartment of Epidemiology,University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, Box 357236, Seattle, WA, United StatesBackground: Despite high efficacy of oral antiretroviral therapy (ART), viral suppression among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA) remains low. Compared to daily oral ART, bimonthly long-acting injectable ART (LA-ART) may simplify adherence, improve clinical outcomes, and decrease HIV transmission in this priority population. However, LA-ART will likely cost more than oral ART and the cost threshold at which LA-ART will be cost effective in SSA has not been evaluated. Methods: We adapted a mathematical model of HIV transmission and progression in Kenya to include HIV acquisition and viral suppression among AYA (age 10–24). We projected the population-level health and economic impact of providing LA-ART to AYA over a 10-year time horizon assuming oral ART costs of US$233 annually and a two-month duration of viral suppression per LA-ART injection. We calculated the maximum cost at which switching from oral to LA-ART would be considered cost-effective, using thresholds of $500 and $1,508 per disability-adjusted life year averted (WHO's threshold of HIV treatment interventions and Kenya's gross domestic product per capita). Findings: Assuming 85% of AYA switch from oral to injectable formulations, LA-ART is estimated to prevent 40,540 infections and 20,480 deaths over 10 years. The maximum increase in the annual per-person cost of receiving LA-ART is estimated to be $89 and $236 for LA-ART to be cost-effective under the thresholds of $500 and $1,508 per DALY averted, respectively. The cost threshold was lower when non-adherent oral ART AYA users were assumed to be less likely to switch to LA-ART. Interpretation: Providing LA-ART to AYA can be cost-effective in Kenya if it is less than twice the cost of oral ART. Long-acting injectable ART for priority populations with low viral suppression has the potential to cost-effectively avert disability and death. Funding: National Institutes of Health (R01 HD085807; PI: Kohler)http://www.sciencedirect.com/science/article/pii/S2589537020301978AdolescentYoung adultModelingLong-acting ARTKenyaCost-effectiveness |
| spellingShingle | Jessica Culhane Monisha Sharma Kate Wilson D.Allen Roberts Cyrus Mugo Dalton Wamalwa Irene Inwani Ruanne V. Barnabas Pamela K. Kohler Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya EClinicalMedicine Adolescent Young adult Modeling Long-acting ART Kenya Cost-effectiveness |
| title | Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya |
| title_full | Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya |
| title_fullStr | Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya |
| title_full_unstemmed | Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya |
| title_short | Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya |
| title_sort | modeling the health impact and cost threshold of long acting art for adolescents and young adults in kenya |
| topic | Adolescent Young adult Modeling Long-acting ART Kenya Cost-effectiveness |
| url | http://www.sciencedirect.com/science/article/pii/S2589537020301978 |
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