PMID- 28906279
DCOM- 20180514
LR  - 20180523
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 31
IP  - 15
DP  - 2017 Sep 24
TI  - The value of point-of-care CD4+ and laboratory viral load in tailoring
      antiretroviral therapy monitoring strategies to resource limitations.
PG  - 2135-2145
LID - 10.1097/QAD.0000000000001586 [doi]
AB  - OBJECTIVE: To examine the clinical and economic value of point-of-care CD4
      (POC-CD4) or viral load monitoring compared with current practices in Mozambique,
      a country representative of the diverse resource limitations encountered by HIV
      treatment programs in sub-Saharan Africa. DESIGN/METHODS: We use the
      Cost-Effectiveness of Preventing AIDS Complications-International model to
      examine the clinical impact, cost (2014 US$), and incremental cost-effectiveness 
      ratio [$/year of life saved (YLS)] of ART monitoring strategies in Mozambique. We
      compare: monitoring for clinical disease progression [clinical ART monitoring
      strategy (CLIN)] vs. annual POC-CD4 in rural settings without laboratory services
      and biannual laboratory CD4 (LAB-CD4), biannual POC-CD4, and annual viral load in
      urban settings with laboratory services. We examine the impact of a range of
      values in sensitivity analyses, using Mozambique's 2014 per capita gross domestic
      product ($620) as a benchmark cost-effectiveness threshold. RESULTS: In rural
      settings, annual POC-CD4 compared to CLIN improves life expectancy by 2.8 years, 
      reduces time on failed ART by 0.6 years, and yields an incremental
      cost-effectiveness ratio of $480/YLS. In urban settings, biannual POC-CD4 is more
      expensive and less effective than viral load. Compared to biannual LAB-CD4, viral
      load improves life expectancy by 0.6 years, reduces time on failed ART by 1.0
      year, and is cost-effective ($440/YLS). CONCLUSION: In rural settings, annual
      POC-CD4 improves clinical outcomes and is cost-effective compared to CLIN. In
      urban settings, viral load has the greatest clinical benefit and is
      cost-effective compared to biannual POC-CD4 or LAB-CD4. Tailoring ART monitoring 
      strategies to specific settings with different available resources can improve
      clinical outcomes while remaining economically efficient.
FAU - Hyle, Emily P
AU  - Hyle EP
AD  - aMedical Practice Evaluation Center bDivision of Infectious Diseases,
      Massachusetts General Hospital, Boston, Massachusetts, USA cInstituto Nacional de
      Saude, Maputo, Mozambique dDivision of General Internal Medicine, Massachusetts
      General Hospital, Boston, Massachusetts, USA eDesmond Tutu HIV Centre, Cape Town,
      South Africa fCenter for Decision Science, Harvard T.H. Chan School of Public
      Health, Boston gClinton Health Access Initiative, Boston hHarvard University
      Center for AIDS Research, Harvard Medical School, Boston, Massachusetts, USA
      iClinton Health Access Initiative, Gaborone, Botswana jBiostatistics Center,
      Massachusetts General Hospital, Boston, Massachusetts, USA.
FAU - Jani, Ilesh V
AU  - Jani IV
FAU - Rosettie, Katherine L
AU  - Rosettie KL
FAU - Wood, Robin
AU  - Wood R
FAU - Osher, Benjamin
AU  - Osher B
FAU - Resch, Stephen
AU  - Resch S
FAU - Pei, Pamela P
AU  - Pei PP
FAU - Maggiore, Paolo
AU  - Maggiore P
FAU - Freedberg, Kenneth A
AU  - Freedberg KA
FAU - Peter, Trevor
AU  - Peter T
FAU - Parker, Robert A
AU  - Parker RA
FAU - Walensky, Rochelle P
AU  - Walensky RP
LA  - eng
GR  - K01 HL123349/HL/NHLBI NIH HHS/United States
GR  - R01 AI058736/AI/NIAID NIH HHS/United States
GR  - R37 AI093269/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, N.I.H., Extramural
PL  - England
JT  - AIDS (London, England)
JID - 8710219
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
SB  - X
MH  - Adult
MH  - Anti-Retroviral Agents/*therapeutic use
MH  - CD4 Lymphocyte Count/economics/*methods
MH  - Cost-Benefit Analysis
MH  - Drug Monitoring/economics/*methods
MH  - Female
MH  - HIV Infections/*drug therapy
MH  - Humans
MH  - Male
MH  - Mozambique
MH  - *Point-of-Care Systems
MH  - Rural Population
MH  - Treatment Outcome
MH  - Urban Population
MH  - Viral Load/economics/*methods
MH  - Young Adult
PMC - PMC5634708
MID - NIHMS892030
EDAT- 2017/09/15 06:00
MHDA- 2018/05/15 06:00
CRDT- 2017/09/15 06:00
PMCR- 2018/09/24 00:00
PHST- 2018/09/24 00:00 [pmc-release]
PHST- 2017/09/15 06:00 [entrez]
PHST- 2017/09/15 06:00 [pubmed]
PHST- 2018/05/15 06:00 [medline]
AID - 10.1097/QAD.0000000000001586 [doi]
AID - 00002030-201709240-00012 [pii]
PST - ppublish
SO  - AIDS. 2017 Sep 24;31(15):2135-2145. doi: 10.1097/QAD.0000000000001586.