Duke Global Health Institute, Duke University, Durham, NC 27701, USA.
J Acquir Immune Defic Syndr. 2011 Apr 15;56(5):443-52. doi: 10.1097/QAI.0b013e3182118f8c.
Guidelines in sub-Saharan Africa on when HIV-seronegative persons should retest range from never to annually for lower-risk populations and from annually to every 3 months for high-risk populations.
We designed a mathematical model to compare the cost-effectiveness of alternative HIV retesting frequencies. Cost of HIV counseling and testing, linkage to care, treatment costs, disease progression, and mortality, and HIV transmission are modeled for three hypothetical cohorts with posited annual HIV incidence of 0.8%, 1.3%, and 4.0%, respectively. The model compared costs, quality-adjusted life-years gained, and secondary infections averted from testing intervals ranging from 3 months to 30 years. Input parameters from sub-Saharan Africa were used and explored in sensitivity analyses.
Accounting for secondary infections averted, the most cost-effective testing frequency was every 7.5 years for 0.8% incidence, every 5 years for 1.3% incidence, and every 2 years for 4.0% incidence. Optimal testing strategies and their relative cost-effectiveness were most sensitive to assumptions about HIV counseling and testing and treatment costs, rates of CD4 decline, rates of HIV transmission, and whether tertiary infections averted were taken into account.
While higher risk populations merit more frequent HIV testing than low risk populations, regular retesting is beneficial even in low-risk populations. Our data demonstrate benefits of tailoring testing intervals to resource constraints and local HIV incidence rates.
撒哈拉以南非洲地区关于 HIV 血清阴性者何时应重新检测的指南，对于低危人群，范围从无需检测到每年检测；对于高危人群，范围从每年检测到每 3 个月检测。
我们设计了一个数学模型，以比较不同 HIV 重新检测频率的成本效益。对于假定的每年 HIV 发病率分别为 0.8%、1.3%和 4.0%的三个假设队列，对 HIV 咨询和检测、与护理机构的衔接、治疗费用、疾病进展和死亡率以及 HIV 传播进行了成本建模。该模型比较了从 3 个月到 30 年不等的检测间隔所带来的成本、获得的质量调整生命年以及避免的二次感染。使用了来自撒哈拉以南非洲的输入参数，并在敏感性分析中进行了探讨。
考虑到避免的二次感染，0.8%发病率的最具成本效益的检测频率是每 7.5 年一次，1.3%发病率的检测频率是每 5 年一次，4.0%发病率的检测频率是每 2 年一次。最佳检测策略及其相对成本效益对 HIV 咨询和检测以及治疗费用、CD4 下降率、HIV 传播率以及是否考虑避免三级感染的假设最为敏感。
虽然高危人群比低危人群更需要频繁的 HIV 检测，但即使在低危人群中，定期重新检测也是有益的。我们的数据表明，根据资源限制和当地 HIV 发病率调整检测间隔是有益的。
