PMID- 29136117
OWN - NLM
STAT- In-Data-Review
LR  - 20180504
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Linking)
VI  - 66
IP  - 8
DP  - 2018 Apr 3
TI  - Cost-Effectiveness of Community-based Human Immunodeficiency Virus Self-Testing
      in Blantyre, Malawi.
PG  - 1211-1221
LID - 10.1093/cid/cix983 [doi]
AB  - Background: Human immunodeficiency virus self-testing (HIVST) is effective, with 
      scale-up underway in sub-Saharan Africa. We assessed cost-effectiveness of adding
      HIVST to existing facility-based HIV testing and counseling (HTC) services. Both 
      2010 (initiate at CD4 <350 cells/muL) and 2015 (initiate all) World Health
      Organization (WHO) guidelines for antiretroviral treatment (ART) were considered.
      Methods: A microsimulation model was developed to evaluate cost-effectiveness,
      from both health provider and societal perspectives, of an HIVST service
      implemented in a cluster-randomized trial (CRT; ISRCTN02004005) in Malawi. Costs 
      and health outcomes were evaluated over a 20-year time horizon, using a discount 
      rate of 3%. Probabilistic sensitivity analysis was conducted to account for
      parameter uncertainty. Results: From the health provider perspective and 20-year 
      time horizon, facility HTC using 2010 WHO ART guidelines was the least costly
      ($294.71 per person; 95% credible interval [CrI], 270.79-318.45) and least
      effective (11.64 quality-adjusted life-years [QALYs] per person; 95% CrI,
      11.43-11.86) strategy. Compared with this strategy, the incremental
      cost-effectiveness ratio (ICER) for facility HTC using 2015 WHO ART guidelines
      was $226.85 (95% CrI, 198.79-284.35) per QALY gained. The strategy of facility
      HTC plus HIVST, using 2010 WHO ART guidelines, was extendedly dominated. The ICER
      for facility HTC plus HIVST, using 2015 WHO ART guidelines, was $253.90 (95% CrI,
      201.71-342.02) per QALY gained compared with facility HTC and using 2015 WHO ART 
      guidelines. Conclusions: HIVST may be cost-effective in a Malawian population
      with high HIV prevalence. HIVST is suited to an early HIV diagnosis and treatment
      strategy. Clinical Trials registration: ISRCTN02004005.
FAU - Maheswaran, Hendramoorthy
AU  - Maheswaran H
AD  - Department of Public Health and Policy, University of Liverpool, United Kingdom.
AD  - Division of Health Sciences, University of Warwick Medical School, Coventry,
      United Kingdom.
AD  - Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
FAU - Clarke, Aileen
AU  - Clarke A
AD  - Division of Health Sciences, University of Warwick Medical School, Coventry,
      United Kingdom.
FAU - MacPherson, Peter
AU  - MacPherson P
AD  - Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
AD  - Department of Clinical Sciences, Liverpool School of Tropical Medicine, United
      Kingdom.
FAU - Kumwenda, Felistas
AU  - Kumwenda F
AD  - Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
FAU - Lalloo, David G
AU  - Lalloo DG
AD  - Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
AD  - Department of Clinical Sciences, Liverpool School of Tropical Medicine, United
      Kingdom.
FAU - Corbett, Elizabeth L
AU  - Corbett EL
AD  - Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
AD  - London School of Hygiene and Tropical Medicine, United Kingdom.
FAU - Petrou, Stavros
AU  - Petrou S
AD  - Division of Health Sciences, University of Warwick Medical School, Coventry,
      United Kingdom.
LA  - eng
GR  - G0501681/Medical Research Council/United Kingdom
PT  - Journal Article
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases
      Society of America
JID - 9203213
PMC - PMC5889018
EDAT- 2017/11/15 06:00
MHDA- 2017/11/15 06:00
CRDT- 2017/11/15 06:00
PHST- 2017/07/17 00:00 [received]
PHST- 2017/11/08 00:00 [accepted]
PHST- 2017/11/15 06:00 [pubmed]
PHST- 2017/11/15 06:00 [medline]
PHST- 2017/11/15 06:00 [entrez]
AID - 4609427 [pii]
AID - 10.1093/cid/cix983 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2018 Apr 3;66(8):1211-1221. doi: 10.1093/cid/cix983.