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

Show simple item record

dc.contributor.author Wood, Robin
dc.contributor.author Paltiel, A. David
dc.contributor.author Lorenzana, Sarah B.
dc.contributor.author Anglaret, Xavier
dc.contributor.author Stoler, Adam W.
dc.contributor.author Walensky, Rochelle P.
dc.contributor.author Ciaranello, Andrea Lynne
dc.contributor.author Freedberg, Kenneth Alan
dc.date.accessioned 2011-05-19T01:20:29Z
dc.date.issued 2010
dc.identifier.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. en_US
dc.identifier.issn 1549-1277 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:4891671
dc.description.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. en_US
dc.language.iso en_US en_US
dc.publisher Public Library of Science en_US
dc.relation.isversionof doi:10.1371/journal.pmed.1000382 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014084/pdf/ en_US
dash.license LAA
dc.subject infectious diseases en_US
dc.subject HIV infection and AIDS en_US
dc.subject public health and epidemiology en_US
dc.subject global health en_US
dc.subject health policy en_US
dc.title Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal PLoS Medicine en_US
dash.depositing.author Walensky, Rochelle P.
dc.date.available 2011-05-19T01:20:29Z
dash.affiliation.other HMS^Medicine-Massachusetts General Hospital en_US
dash.affiliation.other HMS^Medicine-Massachusetts General Hospital en_US
dash.affiliation.other SPH^Health Policy and Management en_US

Files in this item

Files Size Format View
3014084.pdf 433.8Kb PDF View/Open

This item appears in the following Collection(s)

Show simple item record

 
 

Search DASH


Advanced Search
 
 

Submitters