HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost–Utility Analysis
IntroductionHIV is considered one of the most important chronic transmitted diseases worldwide. The Joint United Nations Program on HIV/AIDS in 2020 proposed the strategy “95–95–95” which goals to achieve a 95% of cases identified, receives ART, and will have achieved suppression of the virus. In Ec...
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2022.884313/full |
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| author | Paulina Quirola-Amores Paulina Quirola-Amores Pablo Espinosa Pablo Espinosa Sebastian Oleas Isabel Hernandez Aquiles R. Henriquez Enrique Teran Enrique Teran |
| author_facet | Paulina Quirola-Amores Paulina Quirola-Amores Pablo Espinosa Pablo Espinosa Sebastian Oleas Isabel Hernandez Aquiles R. Henriquez Enrique Teran Enrique Teran |
| author_sort | Paulina Quirola-Amores |
| collection | DOAJ |
| description | IntroductionHIV is considered one of the most important chronic transmitted diseases worldwide. The Joint United Nations Program on HIV/AIDS in 2020 proposed the strategy “95–95–95” which goals to achieve a 95% of cases identified, receives ART, and will have achieved suppression of the virus. In Ecuador by 2020, according to the Ministry of Public Health, 45,056 persons are living with HIV, principally men between 15 and 49 years, and a mortality rate of 4.8/100,000 habitats. This study aims to determine the cost–utility of applying an early screening to a sexually active population vs. only a high-risk population and if the use of PrEP is justified depending on different contexts.MethodsFor the cost–utility evaluation, it was compared: (a) HIV screening performed only in the high-risk population vs. HIV screening in all population sexually active; and (b) the use of ART only for HIV treatment vs. ART as a treatment in diagnosed cases and the use of PrEP (only at a high-risk population of acquiring HIV). Calculation and weight of DALYs for HIV/SIDA were obtained through WHO guidelines. To generate the Markov model for HIV/AIDS, subjects were classified as symptomatic or asymptomatic, as well as the HIV deaths.ResultsCost–benefit analysis (CUA) showed that ICER for early diagnosis had a negative value which means a saving if the strategy will be implemented as a regular test (–$591, –$4,360) and −108 and −934 DALYs, in the case of ART and PrEP, ICER the $30,541–$59,410, which resulted in more than the GDP's threshold and health years between 2,511 and 10,635 in the general population. With a reduction of 70% in the assigned budget for the early diagnosis, Ecuadorian people could lose between 4 and 6 DALYs, while if the budget reduces more than 50% to ART, it will generate a loss of 10–12 years of healthy life.ConclusionCUA demonstrates that an early diagnosis in a sexually active population is cost-beneficial. This, combined with ART or PrEP, is ideal to add years of healthy life. |
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| id | doaj.art-44edea87e9a248da934c4327256215b4 |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-12-12T12:34:11Z |
| publishDate | 2022-06-01 |
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| series | Frontiers in Public Health |
| spelling | doaj.art-44edea87e9a248da934c4327256215b42022-12-22T00:24:22ZengFrontiers Media S.A.Frontiers in Public Health2296-25652022-06-011010.3389/fpubh.2022.884313884313HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost–Utility AnalysisPaulina Quirola-Amores0Paulina Quirola-Amores1Pablo Espinosa2Pablo Espinosa3Sebastian Oleas4Isabel Hernandez5Aquiles R. Henriquez6Enrique Teran7Enrique Teran8Instituto de Microbiología, Universidad San Francisco de Quito, Quito, EcuadorColegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, EcuadorColegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, EcuadorFacultad de Medicina, Medicina, Universidad de Las Américas, Quito, EcuadorInstituto de Economía, Universidad San Francisco de Quito, Quito, EcuadorColegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, EcuadorOne Health Research Group, Universidad de Las Americas, Quito, EcuadorInstituto de Microbiología, Universidad San Francisco de Quito, Quito, EcuadorColegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, EcuadorIntroductionHIV is considered one of the most important chronic transmitted diseases worldwide. The Joint United Nations Program on HIV/AIDS in 2020 proposed the strategy “95–95–95” which goals to achieve a 95% of cases identified, receives ART, and will have achieved suppression of the virus. In Ecuador by 2020, according to the Ministry of Public Health, 45,056 persons are living with HIV, principally men between 15 and 49 years, and a mortality rate of 4.8/100,000 habitats. This study aims to determine the cost–utility of applying an early screening to a sexually active population vs. only a high-risk population and if the use of PrEP is justified depending on different contexts.MethodsFor the cost–utility evaluation, it was compared: (a) HIV screening performed only in the high-risk population vs. HIV screening in all population sexually active; and (b) the use of ART only for HIV treatment vs. ART as a treatment in diagnosed cases and the use of PrEP (only at a high-risk population of acquiring HIV). Calculation and weight of DALYs for HIV/SIDA were obtained through WHO guidelines. To generate the Markov model for HIV/AIDS, subjects were classified as symptomatic or asymptomatic, as well as the HIV deaths.ResultsCost–benefit analysis (CUA) showed that ICER for early diagnosis had a negative value which means a saving if the strategy will be implemented as a regular test (–$591, –$4,360) and −108 and −934 DALYs, in the case of ART and PrEP, ICER the $30,541–$59,410, which resulted in more than the GDP's threshold and health years between 2,511 and 10,635 in the general population. With a reduction of 70% in the assigned budget for the early diagnosis, Ecuadorian people could lose between 4 and 6 DALYs, while if the budget reduces more than 50% to ART, it will generate a loss of 10–12 years of healthy life.ConclusionCUA demonstrates that an early diagnosis in a sexually active population is cost-beneficial. This, combined with ART or PrEP, is ideal to add years of healthy life.https://www.frontiersin.org/articles/10.3389/fpubh.2022.884313/fullHIV screeningHIV treatmentARTPrEP implementationDALYscost–utility analysis |
| spellingShingle | Paulina Quirola-Amores Paulina Quirola-Amores Pablo Espinosa Pablo Espinosa Sebastian Oleas Isabel Hernandez Aquiles R. Henriquez Enrique Teran Enrique Teran HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost–Utility Analysis Frontiers in Public Health HIV screening HIV treatment ART PrEP implementation DALYs cost–utility analysis |
| title | HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost–Utility Analysis |
| title_full | HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost–Utility Analysis |
| title_fullStr | HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost–Utility Analysis |
| title_full_unstemmed | HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost–Utility Analysis |
| title_short | HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost–Utility Analysis |
| title_sort | hiv rapid testing in the general population and the usefulness of prep in ecuador a cost utility analysis |
| topic | HIV screening HIV treatment ART PrEP implementation DALYs cost–utility analysis |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2022.884313/full |
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