Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa
Background<br> Viral load (VL) testing is recommended for monitoring people on ART. The National Health Laboratory Service (NHLS) in South Africa conducts >5million laboratory-based VL tests but faces challenges with specimen integrity and results delivery. Point-of-care (POC) VL monitoring...
| मुख्य लेखकों: | , , |
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| स्वरूप: | Journal article |
| भाषा: | English |
| प्रकाशित: |
Elsevier
2020
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| _version_ | 1826293732762189824 |
|---|---|
| author | Girdwood, SJ Crompton, T Dorward, J |
| author_facet | Girdwood, SJ Crompton, T Dorward, J |
| author_sort | Girdwood, SJ |
| collection | OXFORD |
| description | Background<br>
Viral load (VL) testing is recommended for monitoring people on ART. The National Health Laboratory Service (NHLS) in South Africa conducts >5million laboratory-based VL tests but faces challenges with specimen integrity and results delivery. Point-of-care (POC) VL monitoring may improve VL suppression (VLS). We assessed the cost-effectiveness of different strategies for POC testing in South Africa.
<br><br>Methods<br>
We developed a cost-outcome model utilizing NHLS data, including facility-level annual VL volumes, proportion with VLS, specimen rejection rates, turn-around-time, and the cost/test. We assessed the impact of adopting POC VL technology under 4 strategies: (1) status-quo; (2) targeted POC testing at facilities with high levels of viral failure; (3) targeted POC testing at low-performing facilities; (4) complete POC adoption. For each strategy, we determined the total cost, effectiveness (expected number of virally suppressed people) and incremental cost-effectiveness ratio (ICER) based on expected (>10%) VLS improvement.
<br><br>Findings<br>
Existing laboratory-based VL testing costs <span>$</span>126 m annually and achieves 85.2% VLS. Strategy 2 was the most cost-effective approach, with 88.5% VLS and <span>$</span>40/additional person suppressed, compared to the status-quo. Should resources allow, complete POC adoption may be cost-effective (ICER: <span>$</span>136/additional person suppressed), requiring an additional <span>$</span>49 m annually and achieving 94.5% VLS. All other strategies were dominated in the incremental analysis.
<br><br>Interpretation<br>
Assuming POC VL monitoring confers clinical benefits, the most cost-effective strategy for POC adoption in South Africa is a targeted approach with POC VL technologies placed at facilities with high level of viral failure.
<br><br>Funding<br>
Funding support from the Bill & Melinda Gates Foundation.
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| first_indexed | 2024-03-07T03:34:42Z |
| format | Journal article |
| id | oxford-uuid:bbe2c759-1c6c-42ff-90a9-d3b0953965dc |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:34:42Z |
| publishDate | 2020 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:bbe2c759-1c6c-42ff-90a9-d3b0953965dc2022-03-27T05:20:21ZCost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South AfricaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:bbe2c759-1c6c-42ff-90a9-d3b0953965dcEnglishSymplectic ElementsElsevier2020Girdwood, SJCrompton, TDorward, JBackground<br> Viral load (VL) testing is recommended for monitoring people on ART. The National Health Laboratory Service (NHLS) in South Africa conducts >5million laboratory-based VL tests but faces challenges with specimen integrity and results delivery. Point-of-care (POC) VL monitoring may improve VL suppression (VLS). We assessed the cost-effectiveness of different strategies for POC testing in South Africa. <br><br>Methods<br> We developed a cost-outcome model utilizing NHLS data, including facility-level annual VL volumes, proportion with VLS, specimen rejection rates, turn-around-time, and the cost/test. We assessed the impact of adopting POC VL technology under 4 strategies: (1) status-quo; (2) targeted POC testing at facilities with high levels of viral failure; (3) targeted POC testing at low-performing facilities; (4) complete POC adoption. For each strategy, we determined the total cost, effectiveness (expected number of virally suppressed people) and incremental cost-effectiveness ratio (ICER) based on expected (>10%) VLS improvement. <br><br>Findings<br> Existing laboratory-based VL testing costs <span>$</span>126 m annually and achieves 85.2% VLS. Strategy 2 was the most cost-effective approach, with 88.5% VLS and <span>$</span>40/additional person suppressed, compared to the status-quo. Should resources allow, complete POC adoption may be cost-effective (ICER: <span>$</span>136/additional person suppressed), requiring an additional <span>$</span>49 m annually and achieving 94.5% VLS. All other strategies were dominated in the incremental analysis. <br><br>Interpretation<br> Assuming POC VL monitoring confers clinical benefits, the most cost-effective strategy for POC adoption in South Africa is a targeted approach with POC VL technologies placed at facilities with high level of viral failure. <br><br>Funding<br> Funding support from the Bill & Melinda Gates Foundation. |
| spellingShingle | Girdwood, SJ Crompton, T Dorward, J Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa |
| title | Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa |
| title_full | Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa |
| title_fullStr | Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa |
| title_full_unstemmed | Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa |
| title_short | Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa |
| title_sort | cost effectiveness of adoption strategies for point of care hiv viral load monitoring in south africa |
| work_keys_str_mv | AT girdwoodsj costeffectivenessofadoptionstrategiesforpointofcarehivviralloadmonitoringinsouthafrica AT cromptont costeffectivenessofadoptionstrategiesforpointofcarehivviralloadmonitoringinsouthafrica AT dorwardj costeffectivenessofadoptionstrategiesforpointofcarehivviralloadmonitoringinsouthafrica |