Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis

DSpace/Manakin Repository

Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis

Citable link to this page

. . . . . .

Title: Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis
Author: Wood, Robin; Paltiel, A. David; Lorenzana, Sarah B.; Anglaret, Xavier; Stoler, Adam W.; Walensky, Rochelle P.; Ciaranello, Andrea Lynne; Freedberg, Kenneth Alan

Note: Order does not necessarily reflect citation order of authors.

Citation: Walensky, Rochelle P., Robin Wood, Andrea L. Ciaranello, A. David Paltiel, Sarah B. Lorenzana, Xavier Anglaret, Adam W. Stoler, and Kenneth A. Freedberg. 2010. Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis. PLoS Medicine 7(12): e1000382.
Full Text & Related Files:
Abstract: Background: The new 2010 World Health Organization (WHO) HIV treatment guidelines recommend earlier antiretroviral therapy (ART) initiation (CD4,350 cells/ml instead of CD4,200 cells/ml), multiple sequential ART regimens, and replacement of first-line stavudine with tenofovir. This paper considers what to do first in resource-limited settings where immediate implementation of all of the WHO recommendations is not feasible. Methods and Findings: We use a mathematical model and local input data to project clinical and economic outcomes in a South African HIV-infected cohort (mean age = 32.8 y, mean CD4 = 375/ml). For the reference strategy, we assume that all patients initiate stavudine-based ART with WHO stage III/IV disease and receive one line of ART (stavudine/WHO/one-line). We rank—in survival, cost-effectiveness, and equity terms—all 12 possible combinations of the following: (1) stavudine replacement with tenofovir, (2) ART initiation (by WHO stage, CD4,200 cells/ml, or CD4,350 cells/ml), and (3) one or two regimens, or lines, of available ART. Projected life expectancy for the reference strategy is 99.0 mo. Considering each of the guideline components separately, 5-y survival is maximized with ART initiation at CD4,350 cells/ml (stavudine/,350/ml/ one-line, 87% survival) compared with stavudine/WHO/two-lines (66%) and tenofovir/WHO/one-line (66%). The greatest life expectancies are achieved via the following stepwise programmatic additions: stavudine/,350/ml/one-line (124.3 mo), stavudine/,350/ml/two-lines (177.6 mo), and tenofovir/,350/ml/two-lines (193.6 mo). Three program combinations are economically efficient: stavudine/,350/ml/one-line (cost-effectiveness ratio, US$610/years of life saved [YLS]), tenofovir/ ,350/ml/one-line (US$1,140/YLS), and tenofovir/,350/ml/two-lines (US$2,370/YLS). Conclusions: In settings where immediate implementation of all of the new WHO treatment guidelines is not feasible, ART initiation at CD4,350 cells/ml provides the greatest short- and long-term survival advantage and is highly cost-effective.
Published Version: doi:10.1371/journal.pmed.1000382
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014084/pdf/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:4891671

Show full Dublin Core record

This item appears in the following Collection(s)

 
 

Search DASH


Advanced Search
 
 

Submitters