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
Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America.
Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
PLoS One. 2014 Jan 22;9(1):e85197. doi: 10.1371/journal.pone.0085197. eCollection 2014.
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.
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.
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.
移动艾滋病毒筛查可能有助于早期艾滋病毒诊断。我们的目标是研究在南非开普敦现有的基于医疗机构的艾滋病毒检测中增加一个移动筛查单位的成本效益。
我们使用国际预防艾滋病并发症成本效益（CEPAC - I）计算机模拟模型来评估开普敦的两种艾滋病毒筛查策略：1）基于医疗机构的检测（当前的护理标准）和2）在同一社区增加一个移动艾滋病毒检测单位干预措施。基线输入参数来自一个在开普敦的移动单位，该单位在两年内检测了18,870人：既往未诊断艾滋病毒的患病率（6.6%）、诊断时的平均CD4细胞计数（男性423/µL，女性516/µL）、与护理率相关的CD4细胞计数（男性31% - 58%，女性49% - 58%）、移动单位干预成本（包括购置、运营和艾滋病毒检测成本，每个阴性结果29.30美元，每个阳性结果31.30美元）。我们进行了广泛的敏感性分析以评估输入的不确定性。模型结果包括艾滋病毒诊断地点、预期寿命、医疗成本以及与基于医疗机构检测相比干预措施的增量成本效益比（ICER）。当ICER低于南非的人均国内生产总值（2012年为8200美元）时，我们认为该干预措施“非常具有成本效益”。我们预计，采用基于医疗机构的检测，经贴现（未贴现）的艾滋病毒感染人群预期寿命为132.2（197.7）个月；增加移动单位后，这一数字增加到140.7（211.7）个月。移动单位的ICER为每挽救一年生命（YLS）2400美元。结果对既往未诊断艾滋病毒的患病率、与护理的关联率以及医疗机构艾滋病毒检测频率最为敏感。
在当前检测项目中增加移动艾滋病毒筛查可以提高生存率，在南非和其他资源有限的环境中非常具有成本效益，应作为优先事项。
