Mobile HIV Screening in Cape Town, South Africa: Clinical Impact, Cost and Cost-Effectiveness

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Mobile HIV Screening in Cape Town, South Africa: Clinical Impact, Cost and Cost-Effectiveness

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Title: Mobile HIV Screening in Cape Town, South Africa: Clinical Impact, Cost and Cost-Effectiveness
Author: Bassett, Ingrid V.; Govindasamy, Darshini; Erlwanger, Alison S.; Hyle, Emily P.; Kranzer, Katharina; van Schaik, Nienke; Noubary, Farzad; Paltiel, A. David; Wood, Robin; Walensky, Rochelle P.; Losina, Elena; Bekker, Linda-Gail; Freedberg, Kenneth A.

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

Citation: Bassett, I. V., D. Govindasamy, A. S. Erlwanger, E. P. Hyle, K. Kranzer, N. van Schaik, F. Noubary, et al. 2014. “Mobile HIV Screening in Cape Town, South Africa: Clinical Impact, Cost and Cost-Effectiveness.” PLoS ONE 9 (1): e85197. doi:10.1371/journal.pone.0085197. http://dx.doi.org/10.1371/journal.pone.0085197.
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Abstract: Background: Mobile HIV screening may facilitate early HIV diagnosis. Our objective was to examine the cost-effectiveness of adding a mobile screening unit to current medical facility-based HIV testing in Cape Town, South Africa. Methods and Findings: We used the Cost Effectiveness of Preventing AIDS Complications International (CEPAC-I) computer simulation model to evaluate two HIV screening strategies in Cape Town: 1) medical facility-based testing (the current standard of care) and 2) addition of a mobile HIV-testing unit intervention in the same community. Baseline input parameters were derived from a Cape Town-based mobile unit that tested 18,870 individuals over 2 years: prevalence of previously undiagnosed HIV (6.6%), mean CD4 count at diagnosis (males 423/µL, females 516/µL), CD4 count-dependent linkage to care rates (males 31%–58%, females 49%–58%), mobile unit intervention cost (includes acquisition, operation and HIV test costs, $29.30 per negative result and $31.30 per positive result). We conducted extensive sensitivity analyses to evaluate input uncertainty. Model outcomes included site of HIV diagnosis, life expectancy, medical costs, and the incremental cost-effectiveness ratio (ICER) of the intervention compared to medical facility-based testing. We considered the intervention to be “very cost-effective” when the ICER was less than South Africa's annual per capita Gross Domestic Product (GDP) ($8,200 in 2012). We projected that, with medical facility-based testing, the discounted (undiscounted) HIV-infected population life expectancy was 132.2 (197.7) months; this increased to 140.7 (211.7) months with the addition of the mobile unit. The ICER for the mobile unit was $2,400/year of life saved (YLS). Results were most sensitive to the previously undiagnosed HIV prevalence, linkage to care rates, and frequency of HIV testing at medical facilities. Conclusion: The addition of mobile HIV screening to current testing programs can improve survival and be very cost-effective in South Africa and other resource-limited settings, and should be a priority.
Published Version: doi:10.1371/journal.pone.0085197
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898963/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:11879499
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