TCD Outcomes Research (Pty) Ltd, Centurion, South Africa.
Health Economics Unit, School of Economics, University of Nairobi, Nairobi, Kenya.
PLoS One. 2019 Feb 27;14(2):e0212972. doi: 10.1371/journal.pone.0212972. eCollection 2019.
Kenya has the world's 4th largest HIV burden. Various strategies to control the epidemic have been implemented, including the implementation of viral load (VL) testing to monitor HIV patients on ARVs. Like many resource limited settings, Kenya's healthcare system faces serious challenges in effectively providing quality health services to its population. Increased investments to strengthen the country's capacity to diagnose, monitor and treat diseases, particularly HIV and TB, continue to be made but are still inadequate in the face of global health goals like the UNAIDS 90:90:90 which require scaling up of VL tests amid existing constraints. In Kenya, there is an increase in the demand for VL tests amidst these existing constraints. The GeneXpert system is a diagnostic point-of-care technology that can quantify, amongst others, HIV VL. Currently, GeneXpert technology is widely distributed in Kenya for testing of tuberculosis. This study aimed to determine the economic and public health impact of incorporating VL test modules on the existing GeneXpert infrastructure. Markov models were constructed for different populations (non-pregnant adults, pregnant women and children). The scenarios analysed were 100% centralized VL testing compared to 50% GeneXpert plus 50% centralized VL testing, with time horizons of 5 years for the adult and child populations, and 31 months for the pregnant population. Incremental effectiveness was measured in terms of the number of HIV transmissions or opportunistic infections avoided when implementing the GeneXpert scenario compared to a 100% centralized scenario. The model indicated that, for all three populations combined, the GeneXpert scenario resulted in 117 less HIV transmissions and 393 less opportunistic infections. The cost decreased by $21,978,755 for the non-pregnant and pregnant adults and $22,808,533 for non-pregnant adults, pregnant adults and children. The model showed that GeneXpert would cost less and be more effective in terms of total cost per HIV transmission avoided and the total cost per opportunistic infection avoided, except for the pregnant population, when considered separately.
肯尼亚是世界上 HIV 负担第四大的国家。为了控制艾滋病疫情，肯尼亚实施了各种策略，包括进行病毒载量（VL）检测，以监测接受抗逆转录病毒治疗（ARV）的 HIV 患者。与许多资源有限的国家一样，肯尼亚的医疗体系在为其人民提供高质量的卫生服务方面面临着严峻的挑战。为了加强该国诊断、监测和治疗疾病（特别是 HIV 和结核病）的能力，肯尼亚继续增加投资，但面对联合国艾滋病规划署 90-90-90 目标等全球卫生目标，这些投资仍然不足，该目标要求在现有约束条件下扩大 VL 检测。在肯尼亚，由于这些现有约束条件，对 VL 检测的需求不断增加。GeneXpert 系统是一种诊断即时检测技术，可定量检测 HIV VL 等。目前，GeneXpert 技术在肯尼亚广泛用于结核病检测。本研究旨在确定在现有的 GeneXpert 基础设施上增加 VL 检测模块对经济和公共卫生的影响。针对不同人群（非孕妇成年人、孕妇和儿童）构建了 Markov 模型。分析的方案是 100%集中进行 VL 检测与 50% GeneXpert 加 50%集中进行 VL 检测相比，成人和儿童的时间范围为 5 年，孕妇的时间范围为 31 个月。增量效果是通过实施 GeneXpert 方案与 100%集中方案相比，避免 HIV 传播或机会性感染的数量来衡量的。模型表明，对于所有三个人群的综合情况，GeneXpert 方案可减少 117 例 HIV 传播和 393 例机会性感染。对于非孕妇和孕妇成年人，成本降低了 21978755 美元，对于非孕妇成年人、孕妇成年人和儿童，成本降低了 22808533 美元。模型表明，除了孕妇人群外，在考虑到每个方案的每例 HIV 传播或每例机会性感染避免的总成本时，GeneXpert 在总成本方面更有效且成本更低。
