Maheswaran Hendramoorthy, Petrou Stavros, MacPherson Peter, Kumwenda Felistas, Lalloo David G, Corbett Elizabeth L, Clarke Aileen
*Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom; †Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; ‡Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom; §Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; and ‖London School of Hygiene and Tropical Medicine, London, United Kingdom.
J Acquir Immune Defic Syndr. 2017 Jul 1;75(3):280-289. doi: 10.1097/QAI.0000000000001373.
The scale-up of HIV self-testing (HIVST) in Africa is recommended, but little is known about how this novel approach influences economic outcomes following subsequent antiretroviral treatment (ART) compared with established facility-based HIV testing and counseling (HTC) approaches.
HIV clinics in Blantyre, Malawi.
Consecutive HIV-positive participants, diagnosed by HIVST or facility-based HTC as part of a community cluster-randomized trial (ISRCTN02004005), were followed from initial assessment for ART until 1-year postinitiation. Healthcare resource use was prospectively measured, and primary costing studies undertaken to estimate total health provider costs. Participants were interviewed to establish direct nonmedical and indirect costs over the first year of ART. Costs were adjusted to 2014 US$ and INT$. Health-related quality of life was measured using the EuroQol EQ-5D at each clinic visit. Multivariable analyses estimated predictors of economic outcomes.
Of 325 participants attending HIV clinics for assessment for ART, 265 were identified through facility-based HTC, and 60 through HIVST; 168/265 (69.2%) and 36/60 (60.0%), respectively, met national ART eligibility criteria and initiated treatment. The mean total health provider assessment costs for ART initiation were US$22.79 (SE: 0.56) and US$19.92 (SE: 0.77) for facility-based HTC and HIVST participants, respectively, and was US$2.87 (bootstrap 95% CI: US$1.01 to US$4.73) lower for the HIVST group. The mean total health provider costs for the first year of ART were US$168.65 (SE: 2.02) and US$164.66 (SE: 4.21) for facility-based HTC and HIVST participants, respectively, and comparable between the 2 groups (bootstrap 95% CI: -US$12.38 to US$4.39). EQ-5D utility scores immediately before and one year after ART initiation were comparable between the 2 groups. EQ-5D utility scores 1 year after ART initiation had increased by 0.129 (SE: 0.011) and 0.139 (SE: 0.027) for facility-based HTC and HIVST participants, respectively.
Once HIV self-testers are linked into HIV services, their economic outcomes are comparable to those linking to services after facility-based HTC.
在非洲扩大艾滋病毒自我检测（HIVST）是被推荐的，但与既定的基于机构的艾滋病毒检测与咨询（HTC）方法相比，这种新方法对后续抗逆转录病毒治疗（ART）后的经济结果有何影响，目前知之甚少。
马拉维布兰太尔的艾滋病毒诊所。
作为社区整群随机试验（ISRCTN02004005）的一部分，通过HIVST或基于机构的HTC诊断出的连续HIV阳性参与者，从ART初始评估开始随访至治疗开始后1年。前瞻性地测量医疗资源使用情况，并进行主要成本研究以估计医疗服务提供者的总成本。对参与者进行访谈以确定ART第一年的直接非医疗成本和间接成本。成本调整为2014年美元和国际元。在每次诊所就诊时使用欧洲五维度健康量表（EuroQol EQ-5D）测量健康相关生活质量。多变量分析估计经济结果的预测因素。
在325名到艾滋病毒诊所进行ART评估的参与者中，265名通过基于机构的HTC确定，60名通过HIVST确定；分别有168/265（69.2%）和36/60（60.0%）符合国家ART资格标准并开始治疗。基于机构的HTC参与者和HIVST参与者开始ART时医疗服务提供者的平均总评估成本分别为22.79美元（标准误：0.56）和19.92美元（标准误：0.77），HIVST组低2.87美元（自抽样95%置信区间：1.01美元至4.73美元）。基于机构的HTC参与者和HIVST参与者ART第一年的医疗服务提供者平均总成本分别为168.65美元（标准误：2.02）和164.66美元（标准误：4.21），两组之间具有可比性（自抽样95%置信区间：-12.38美元至4.39美元）。ART开始前和开始后1年的EQ-5D效用评分在两组之间具有可比性。ART开始后1年，基于机构的HTC参与者和HIVST参与者的EQ-5D效用评分分别增加了0.129（标准误：0.011）和0.139（标准误：0.027）。
一旦艾滋病毒自我检测者与艾滋病毒服务建立联系，他们的经济结果与基于机构的HTC后与服务建立联系者相当。
