Zhong Huaiyang, Arjmand Isabel K, Brandeau Margaret L, Bendavid Eran
Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.
Division of General Medical Disciplines, Department of Medicine, Stanford University, Stanford, CA, USA.
AIDS Care. 2021 Apr;33(4):441-447. doi: 10.1080/09540121.2020.1719966. Epub 2020 Jan 27.
High prevalence of depression among people living with HIV (PLHIV) impedes antiretroviral therapy (ART) adherence and viral suppression. We estimate the effectiveness and cost-effectiveness of strategies to treat depression among PLHIV in Sub-Saharan Africa (SSA). We developed a microsimulation model of HIV disease and care in Uganda which captured individuals' depression status and the relationship between depression and HIV behaviors. We consider a strategy of screening for depression and providing antidepressant therapy with fluoxetine at ART initiation or re-initiation (if a patient has dropped out). We estimate that over 10 years this strategy would reduce prevalence of depression among PLHIV by 16.0% [95% uncertainty bounds 15.8%, 16.1%] from a baseline prevalence of 28%, increase adherence to ART by 1.0% [1.0%, 1.0%], and decrease rates of loss to followup by 3.7% [3.4%, 4.1%]. This would decrease first-line ART failure rates by 2.5% [2.3%, 2.8%] and increase viral suppression rates by 1.0% [1.0%, 1.0%]. This strategy costs $15/QALY compared to the status quo, and was highly cost-effective over a broad range of sensitivity analyses. We conclude that screening for and treating depression among PLHIV in SSA with fluoxetine would be effective in improving HIV treatment outcomes and would be highly cost-effective.
感染艾滋病毒者（PLHIV）中抑郁症的高患病率阻碍了抗逆转录病毒疗法（ART）的依从性和病毒抑制。我们评估了撒哈拉以南非洲（SSA）地区PLHIV抑郁症治疗策略的有效性和成本效益。我们建立了乌干达艾滋病毒疾病和护理的微观模拟模型，该模型捕捉了个体的抑郁状态以及抑郁与艾滋病毒相关行为之间的关系。我们考虑一种在开始或重新开始抗逆转录病毒治疗（如果患者已经停药）时筛查抑郁症并提供氟西汀抗抑郁治疗的策略。我们估计，在10年期间，该策略将使PLHIV中抑郁症的患病率从28%的基线患病率降低16.0%[95%不确定区间为15.8%，16.1%]，使抗逆转录病毒治疗的依从性提高1.0%[1.0%，1.0%]，并使失访率降低3.7%[3.4%，4.1%]。这将使一线抗逆转录病毒治疗失败率降低2.5%[2.3%，2.8%]，并使病毒抑制率提高1.0%[1.0%，1.0%]。与现状相比，该策略的成本为每质量调整生命年15美元，并且在广泛的敏感性分析中具有很高的成本效益。我们得出结论，在SSA地区对PLHIV进行氟西汀筛查和治疗抑郁症将有效改善艾滋病毒治疗结果，并且具有很高的成本效益。
