Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada.
Département de Maladies Infectieuses et Tropicales, Université Alassane Ouattara, Bouaké, Côte d'Ivoire.
J Acquir Immune Defic Syndr. 2019 Apr 15;80(5):503-512. doi: 10.1097/QAI.0000000000001956.
Despite Côte d'Ivoire epidemic being labeled as "generalized," key populations (KPs) are important to overall transmission. Using a dynamic model of HIV transmission, we previously estimated the impact of several treatment-as-prevention strategies that reached-or missed-the UNAIDS 90-90-90 targets in different populations groups, including KP and clients of female sex workers (CFSWs). To inform program planning and resources allocation, we assessed the cost-effectiveness of these scenarios.
Costing was performed from the provider's perspective. Unit costs were obtained from the Ivorian Programme national de lutte contre le Sida (USD 2015) and discounted at 3%. Net incremental cost-effectiveness ratios (ICER) per adult HIV infection prevented and per disability-adjusted life-years (DALY) averted were estimated over 2015-2030.
The 3 most cost-effective and affordable scenarios were the ones that projected current programmatic trends [ICER = $210; 90% uncertainty interval (90% UI): $150-$300], attaining the 90-90-90 objectives among KP and CFSW (ICER = $220; 90% UI: $80-$510), and among KP only (ICER = $290; 90% UI: $90-$660). The least cost-effective scenario was the one that reached the UNAIDS 90-90-90 target accompanied by a 25% point drop in condom use in KP (ICER = $710; 90% UI: $450-$1270). In comparison, the UNAIDS scenario had a net ICER of $570 (90% UI: $390-$900) per DALY averted.
According to commonly used thresholds, accelerating the HIV response can be considered very cost-effective for all scenarios. However, when balancing epidemiological impact, cost-effectiveness, and affordability, scenarios that sustain both high condom use and rates of viral suppression among KP and CFSW seem most promising in Côte d'Ivoire.
尽管科特迪瓦的艾滋病疫情被标记为“广泛流行”，但重点人群（KPs）对整体传播仍然很重要。我们先前使用 HIV 传播的动态模型，评估了几种治疗即预防策略的影响，这些策略针对不同人群，包括重点人群和性工作者的客户（CFSWs），达到或错过了 UNAIDS 的 90-90-90 目标。为了为规划方案和资源分配提供信息，我们评估了这些方案的成本效益。
成本从提供者的角度进行计算。单位成本取自科特迪瓦国家艾滋病防治方案（2015 年美元），并贴现 3%。在 2015 年至 2030 年期间，估计每个成人 HIV 感染预防和每个残疾调整生命年（DALY）避免的净增量成本效益比（ICER）。
3 个最具成本效益和负担得起的方案是那些预测当前方案趋势的方案[ICER = 210 美元；90%置信区间（90%UI）：150-300 美元]，在 KP 和 CFSW 中实现 90-90-90 目标（ICER = 220 美元；90%UI：80-510 美元），仅在 KP 中实现（ICER = 290 美元；90%UI：90-660 美元）。成本效益最低的方案是达到 UNAIDS 90-90-90 目标，同时 KP 中避孕套使用率下降 25%（ICER = 710 美元；90%UI：450-1270 美元）。相比之下，UNAIDS 方案每避免一个 DALY 的净 ICER 为 570 美元（90%UI：390-900 美元）。
根据常用的阈值，加速艾滋病毒应对措施对所有方案来说都非常具有成本效益。然而，当平衡流行病学影响、成本效益和负担能力时，在科特迪瓦，维持 KP 和 CFSW 中高避孕套使用率和病毒抑制率的方案似乎最有希望。
