dc.contributor.author | Ciaranello, Andrea L. | en_US |
dc.contributor.author | Myer, Landon | en_US |
dc.contributor.author | Kelly, Kathleen | en_US |
dc.contributor.author | Christensen, Sarah | en_US |
dc.contributor.author | Daskilewicz, Kristen | en_US |
dc.contributor.author | Doherty, Katie | en_US |
dc.contributor.author | Bekker, Linda-Gail | en_US |
dc.contributor.author | Hou, Taige | en_US |
dc.contributor.author | Wood, Robin | en_US |
dc.contributor.author | Francke, Jordan A. | en_US |
dc.contributor.author | Wools-Kaloustian, Kara | en_US |
dc.contributor.author | Freedberg, Kenneth A. | en_US |
dc.contributor.author | Walensky, Rochelle P. | en_US |
dc.date.accessioned | 2015-04-01T15:25:37Z | |
dc.date.issued | 2015 | en_US |
dc.identifier.citation | Ciaranello, A. L., L. Myer, K. Kelly, S. Christensen, K. Daskilewicz, K. Doherty, L. Bekker, et al. 2015. “Point-of-Care CD4 Testing to Inform Selection of Antiretroviral Medications in South African Antenatal Clinics: A Cost-Effectiveness Analysis.” PLoS ONE 10 (3): e0117751. doi:10.1371/journal.pone.0117751. http://dx.doi.org/10.1371/journal.pone.0117751. | en |
dc.identifier.issn | 1932-6203 | en |
dc.identifier.uri | http://nrs.harvard.edu/urn-3:HUL.InstRepos:14351063 | |
dc.description.abstract | Background: Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. Methods: We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO “Option A”): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). Results: In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs. Conclusions: In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection. | en |
dc.language.iso | en_US | en |
dc.publisher | Public Library of Science | en |
dc.relation.isversionof | doi:10.1371/journal.pone.0117751 | en |
dc.relation.hasversion | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355621/pdf/ | en |
dash.license | LAA | en_US |
dc.title | Point-of-Care CD4 Testing to Inform Selection of Antiretroviral Medications in South African Antenatal Clinics: A Cost-Effectiveness Analysis | en |
dc.type | Journal Article | en_US |
dc.description.version | Version of Record | en |
dc.relation.journal | PLoS ONE | en |
dash.depositing.author | Ciaranello, Andrea L. | en_US |
dc.date.available | 2015-04-01T15:25:37Z | |
dc.identifier.doi | 10.1371/journal.pone.0117751 | * |
dash.authorsordered | false | |
dash.contributor.affiliated | Ciaranello, Andrea | |
dash.contributor.affiliated | Freedberg, Kenneth | |
dash.contributor.affiliated | Walensky, Rochelle | |