Department of Global Health, University of Washington, Seattle, Washington, USA.
Monisha Sharma and Jennifer A. Smith contributed equally to this article.
AIDS. 2018 Jan 14;32(2):233-241. doi: 10.1097/QAD.0000000000001697.
Assisted partner services (aPS) or provider notification for sexual partners of persons diagnosed HIV positive can increase HIV testing and linkage in Sub-Saharan Africa and is a high yield strategy to identify HIV-positive persons. However, its cost-effectiveness is not well evaluated.
Using effectiveness and cost data from an aPS trial in Kenya, we parameterized an individual-based, dynamic HIV transmission model. We estimated costs for both a program scenario and a task-shifting scenario using community health workers to conduct the intervention. We simulated 200 cohorts of 500 000 individuals and projected the health and economic effects of scaling up aPS in a region of western Kenya (formerly Nyanza Province).
Over a 10-year time horizon with universal antiretroviral therapy (ART) initiation, implementing aPS in western Kenya was projected to reach 12.5% of the population and reduce incident HIV infections by 3.7%. In sexual partners receiving aPS, HIV-related deaths were reduced by 13.7%. The incremental cost-effectiveness ratio of aPS was $1094 (US dollars) (90% model variability $823-1619) and $833 (90% model variability $628-1224) per disability-adjusted life year averted under the program and task-shifting scenario, respectively. The incremental cost-effectiveness ratios for both scenarios fall below Kenya's gross domestic product per capita ($1358) and are therefore considered very cost-effective. Results were robust to varying healthcare costs, linkage to care rates, partner concurrency rates, and ART eligibility thresholds (≤350 cells/μl, ≤500 cells/μl, and universal ART).
APS is cost-effective for reducing HIV-related morbidity and mortality in western Kenya and similar settings. Task shifting can increase program affordability.
为 HIV 阳性感染者的性伴侣提供辅助伴侣服务（aPS）或通知其伴侣，可以增加撒哈拉以南非洲地区的 HIV 检测和接触后预防服务的利用率，也是发现 HIV 阳性个体的高效策略。然而，其成本效益尚未得到充分评估。
我们利用肯尼亚一项 aPS 试验的有效性和成本数据，对个体为基础的动态 HIV 传播模型进行了参数化。我们使用社区卫生工作者开展干预的方案和任务转移方案来估计成本。我们模拟了 200 个 50 万个体的队列，并对在肯尼亚西部（前奈亚萨省）扩大 aPS 的卫生和经济影响进行了预测。
在普遍启动抗逆转录病毒治疗（ART）的 10 年时间内，在肯尼亚西部实施 aPS 预计将覆盖 12.5%的人口，并减少 3.7%的新发 HIV 感染。在接受 aPS 的性伴侣中，HIV 相关死亡减少了 13.7%。aPS 的增量成本效益比在方案和任务转移情景下分别为 1094 美元（US 美元）（模型变异的 90%为 823-1619 美元）和 833 美元（90%模型变异为 628-1224 美元），每避免一个残疾调整生命年。两种情景下的增量成本效益比均低于肯尼亚的人均国内生产总值（1358 美元），因此被认为非常具有成本效益。结果在不同的医疗保健成本、接触后预防服务利用率、伴侣同时感染率和 ART 资格标准（≤350 个细胞/μl、≤500 个细胞/μl 和普遍 ART）下都具有稳健性。
在肯尼亚西部和类似环境中，aPS 可降低 HIV 相关发病率和死亡率，具有成本效益。任务转移可以提高项目的可负担性。
