Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old
Improvement of antiretroviral therapy (ART) regimen switching practices and implementation of pretreatment drug resistance (PDR) testing are two potential approaches to improve health outcomes for children living with HIV. We developed a microsimulation model of disease progression and treatment foc...
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MDPI AG
2021-03-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/11/3/567 |
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| author | Mutita Siriruchatanon Shan Liu James G. Carlucci Eva A. Enns Horacio A. Duarte |
| author_facet | Mutita Siriruchatanon Shan Liu James G. Carlucci Eva A. Enns Horacio A. Duarte |
| author_sort | Mutita Siriruchatanon |
| collection | DOAJ |
| description | Improvement of antiretroviral therapy (ART) regimen switching practices and implementation of pretreatment drug resistance (PDR) testing are two potential approaches to improve health outcomes for children living with HIV. We developed a microsimulation model of disease progression and treatment focused on children with perinatally acquired HIV in sub-Saharan Africa who initiate ART at 3 years of age. We evaluated the cost-effectiveness of diagnostic-based strategies (<i>improved switching</i> and <i>PDR testing</i>), over a 10-year time horizon, in settings without and with pediatric dolutegravir (DTG) availability as first-line ART. The <i>improved switching</i> strategy increases the probability of switching to second-line ART when virologic failure is diagnosed through viral load testing. The <i>PDR testing</i> strategy involves a one-time PDR test prior to ART initiation to guide choice of initial regimen. When DTG is not available, PDR testing is dominated by the improved switching strategy, which has an incremental cost-effectiveness ratio (ICER) of USD 579/life-year gained (LY), relative to the status quo. If DTG is available, <i>improved switching</i> has a similar ICER (USD 591/LY) relative to the <i>DTG</i><i>status quo</i>. Even when substantial financial investment is needed to achieve improved regimen switching practices, the <i>improved switching</i> strategy still has the potential to be cost-effective in a wide range of sub-Saharan African countries. Our analysis highlights the importance of strengthening existing laboratory monitoring systems to improve the health of children living with HIV. |
| first_indexed | 2024-03-10T13:02:05Z |
| format | Article |
| id | doaj.art-690da868a16b4325bcfb5320343cd090 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T13:02:05Z |
| publishDate | 2021-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-690da868a16b4325bcfb5320343cd0902023-11-21T11:26:14ZengMDPI AGDiagnostics2075-44182021-03-0111356710.3390/diagnostics11030567Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years OldMutita Siriruchatanon0Shan Liu1James G. Carlucci2Eva A. Enns3Horacio A. Duarte4Department of Industrial & Systems Engineering, University of Washington, Seattle, WA 98185, USADepartment of Industrial & Systems Engineering, University of Washington, Seattle, WA 98185, USADepartment of Pediatrics, Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USADivision of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55408, USADepartment of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA 98105, USAImprovement of antiretroviral therapy (ART) regimen switching practices and implementation of pretreatment drug resistance (PDR) testing are two potential approaches to improve health outcomes for children living with HIV. We developed a microsimulation model of disease progression and treatment focused on children with perinatally acquired HIV in sub-Saharan Africa who initiate ART at 3 years of age. We evaluated the cost-effectiveness of diagnostic-based strategies (<i>improved switching</i> and <i>PDR testing</i>), over a 10-year time horizon, in settings without and with pediatric dolutegravir (DTG) availability as first-line ART. The <i>improved switching</i> strategy increases the probability of switching to second-line ART when virologic failure is diagnosed through viral load testing. The <i>PDR testing</i> strategy involves a one-time PDR test prior to ART initiation to guide choice of initial regimen. When DTG is not available, PDR testing is dominated by the improved switching strategy, which has an incremental cost-effectiveness ratio (ICER) of USD 579/life-year gained (LY), relative to the status quo. If DTG is available, <i>improved switching</i> has a similar ICER (USD 591/LY) relative to the <i>DTG</i><i>status quo</i>. Even when substantial financial investment is needed to achieve improved regimen switching practices, the <i>improved switching</i> strategy still has the potential to be cost-effective in a wide range of sub-Saharan African countries. Our analysis highlights the importance of strengthening existing laboratory monitoring systems to improve the health of children living with HIV.https://www.mdpi.com/2075-4418/11/3/567HIVpretreatment drug resistanceregimen switchingdrug resistance testingNNRTI-based ARTdolutegravir-based ART |
| spellingShingle | Mutita Siriruchatanon Shan Liu James G. Carlucci Eva A. Enns Horacio A. Duarte Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old Diagnostics HIV pretreatment drug resistance regimen switching drug resistance testing NNRTI-based ART dolutegravir-based ART |
| title | Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old |
| title_full | Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old |
| title_fullStr | Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old |
| title_full_unstemmed | Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old |
| title_short | Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old |
| title_sort | addressing pediatric hiv pretreatment drug resistance and virologic failure in sub saharan africa a cost effectiveness analysis of diagnostic based strategies in children ≥3 years old |
| topic | HIV pretreatment drug resistance regimen switching drug resistance testing NNRTI-based ART dolutegravir-based ART |
| url | https://www.mdpi.com/2075-4418/11/3/567 |
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