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PLoS One. 2014 Jan 22;9(1):e85197. doi: 10.1371/journal.pone.0085197. eCollection 2014.

Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness.

Author information

  • 1Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America.
  • 2Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
  • 3Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
  • 4Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
  • 5Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • 6The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, United States of America ; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, United States of America.
  • 7Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America.
  • 8Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa ; Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
  • 9Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America ; Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
  • 10Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America ; Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America ; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
  • 11Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America ; Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America ; Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America.

Abstract

BACKGROUND:

Mobile HIV screening may facilitate early HIV diagnosis. Our objective was to examine the cost-effectiveness of adding a mobile screening unit to current medical facility-based HIV testing in Cape Town, South Africa.

METHODS AND FINDINGS:

We used the Cost Effectiveness of Preventing AIDS Complications International (CEPAC-I) computer simulation model to evaluate two HIV screening strategies in Cape Town: 1) medical facility-based testing (the current standard of care) and 2) addition of a mobile HIV-testing unit intervention in the same community. Baseline input parameters were derived from a Cape Town-based mobile unit that tested 18,870 individuals over 2 years: prevalence of previously undiagnosed HIV (6.6%), mean CD4 count at diagnosis (males 423/µL, females 516/µL), CD4 count-dependent linkage to care rates (males 31%-58%, females 49%-58%), mobile unit intervention cost (includes acquisition, operation and HIV test costs, $29.30 per negative result and $31.30 per positive result). We conducted extensive sensitivity analyses to evaluate input uncertainty. Model outcomes included site of HIV diagnosis, life expectancy, medical costs, and the incremental cost-effectiveness ratio (ICER) of the intervention compared to medical facility-based testing. We considered the intervention to be "very cost-effective" when the ICER was less than South Africa's annual per capita Gross Domestic Product (GDP) ($8,200 in 2012). We projected that, with medical facility-based testing, the discounted (undiscounted) HIV-infected population life expectancy was 132.2 (197.7) months; this increased to 140.7 (211.7) months with the addition of the mobile unit. The ICER for the mobile unit was $2,400/year of life saved (YLS). Results were most sensitive to the previously undiagnosed HIV prevalence, linkage to care rates, and frequency of HIV testing at medical facilities.

CONCLUSION:

The addition of mobile HIV screening to current testing programs can improve survival and be very cost-effective in South Africa and other resource-limited settings, and should be a priority.

PMID:
24465503
[PubMed - indexed for MEDLINE]
PMCID:
PMC3898963
Free PMC Article
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