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AIDS. 2018 Jan 14;32(2):233-241. doi: 10.1097/QAD.0000000000001697.

Assisted partner notification services are cost-effective for decreasing HIV burden in western Kenya.

Author information

1
Department of Global Health, University of Washington, Seattle, Washington, USA.
2
Monisha Sharma and Jennifer A. Smith contributed equally to this article.
3
Imperial College London, Department of Epidemiology, London, UK.
4
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington.
5
Weill Cornell Medical College, New York, New York, USA.
6
Ministry of Health, Nairobi.
7
Kenyatta National Hospital, Nairobi, Kenya.
8
Kelly Government Solutions, Contractor to the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.

Abstract

BACKGROUND:

Assisted partner services (aPS) or provider notification for sexual partners of persons diagnosed HIV positive can increase HIV testing and linkage in Sub-Saharan Africa and is a high yield strategy to identify HIV-positive persons. However, its cost-effectiveness is not well evaluated.

METHODS:

Using effectiveness and cost data from an aPS trial in Kenya, we parameterized an individual-based, dynamic HIV transmission model. We estimated costs for both a program scenario and a task-shifting scenario using community health workers to conduct the intervention. We simulated 200 cohorts of 500 000 individuals and projected the health and economic effects of scaling up aPS in a region of western Kenya (formerly Nyanza Province).

FINDINGS:

Over a 10-year time horizon with universal antiretroviral therapy (ART) initiation, implementing aPS in western Kenya was projected to reach 12.5% of the population and reduce incident HIV infections by 3.7%. In sexual partners receiving aPS, HIV-related deaths were reduced by 13.7%. The incremental cost-effectiveness ratio of aPS was $1094 (US dollars) (90% model variability $823-1619) and $833 (90% model variability $628-1224) per disability-adjusted life year averted under the program and task-shifting scenario, respectively. The incremental cost-effectiveness ratios for both scenarios fall below Kenya's gross domestic product per capita ($1358) and are therefore considered very cost-effective. Results were robust to varying healthcare costs, linkage to care rates, partner concurrency rates, and ART eligibility thresholds (≤350 cells/μl, ≤500 cells/μl, and universal ART).

INTERPRETATION:

APS is cost-effective for reducing HIV-related morbidity and mortality in western Kenya and similar settings. Task shifting can increase program affordability.

PMID:
29135576
PMCID:
PMC5736414
[Available on 2019-01-14]
DOI:
10.1097/QAD.0000000000001697
[Indexed for MEDLINE]

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