Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Int AIDS Soc. 2020 Jun;23 Suppl 1(Suppl 1):e25499. doi: 10.1002/jia2.25499.
As people with HIV age, prevention and management of other communicable and non-communicable diseases (NCDs) will become increasingly important. Integration of screening and treatment for HIV and NCDs is a promising approach for addressing the dual burden of these diseases. The aim of this study was to assess the epidemiological impact and cost-effectiveness of a community-wide integrated programme for screening and treatment of HIV, hypertension and diabetes in Kenya.
Coupling a microsimulation of cardiovascular diseases (CVDs) with a population-based model of HIV dynamics (the Spectrum), we created a hybrid HIV/CVD model. Interventions were modelled from year 2019 (baseline) to 2023, and population was followed to 2033. Analyses were carried at a national level and for three selected regions (Nairobi, Coast and Central).
At a national level, the model projected 7.62 million individuals living with untreated hypertension, 692,000 with untreated diabetes and 592,000 individuals in need of ART in year 2018. Improving ART coverage from 68% at baseline to 88% in 2033 reduced HIV incidence by an estimated 64%. Providing NCD treatment to 50% of diagnosed cases from 2019 to 2023 and maintaining them on treatment afterwards could avert 116,000 CVD events and 43,600 CVD deaths in Kenya over the next 15 years. At a regional level, the estimated impact of expanded HIV services was highest in Nairobi region (averting 42,100 HIV infections compared to baseline) while Central region experienced the highest impact of expanded NCD treatment (with a reduction of 22,200 CVD events). The integrated HIV/NCD intervention could avert 7.76 million disability-adjusted-life-years (DALYs) over 15 years at an estimated cost of $6.68 billion ($445.27 million per year), or $860.30 per DALY averted. At a cost-effectiveness threshold of $2,010 per DALY averted, the probability of cost-effectiveness was 0.92, ranging from 0.71 in Central to 0.92 in Nairobi region.
Integrated screening and treatment of HIV and NCDs can be a cost-effective and impactful approach to save lives of people with HIV in Kenya, although important variation exists at the regional level. Containing the substantial costs required for scale-up will be critical for management of HIV and NCDs on a national scale.
随着艾滋病毒感染者年龄的增长，预防和管理其他传染病和非传染性疾病（NCDs）将变得越来越重要。将艾滋病毒和 NCD 筛查和治疗相结合是应对这些疾病双重负担的一种有前途的方法。本研究旨在评估肯尼亚开展一项针对艾滋病毒、高血压和糖尿病的社区综合筛查和治疗方案的流行病学影响和成本效益。
我们结合心血管疾病（CVDs）的微观模拟和艾滋病毒动力学的基于人群的模型（Spectrum），创建了一种艾滋病毒/心血管疾病混合模型。从 2019 年（基线）到 2023 年对干预措施进行建模，并对人群进行到 2033 年的随访。分析在国家层面和三个选定地区（内罗毕、沿海和中部）进行。
在国家层面，该模型预测 2018 年有 762 万人患有未经治疗的高血压，69.2 万人患有未经治疗的糖尿病，59.2 万人需要接受抗逆转录病毒治疗。到 2033 年，将抗逆转录病毒治疗覆盖率从基线时的 68%提高到 88%，可使艾滋病毒发病率降低约 64%。从 2019 年到 2023 年，对 50%的确诊病例进行非传染性疾病治疗，并在之后维持治疗，在未来 15 年内，肯尼亚可以避免 11.6 万例心血管疾病事件和 4.36 万例心血管疾病死亡。在区域层面，扩大艾滋病毒服务的估计影响在内罗毕地区最高（与基线相比，避免了 4.21 万例艾滋病毒感染），而中部地区扩大非传染性疾病治疗的影响最大（减少了 2.22 万例心血管疾病事件）。艾滋病毒/非传染性疾病综合干预措施可在 15 年内避免 776 万残疾调整生命年（DALYs），估计成本为 66.8 亿美元（每年 44.527 亿美元），或每避免 1 个 DALY 需花费 860.30 美元。在 2010 美元/ DALY 的成本效益阈值下，成本效益的概率为 0.92，从中部的 0.71 到内罗毕的 0.92。
艾滋病毒和非传染性疾病的综合筛查和治疗可能是一种具有成本效益和影响力的方法，可以挽救肯尼亚艾滋病毒感染者的生命，但在区域层面存在重要差异。控制扩大规模所需的大量成本对于国家一级艾滋病毒和非传染性疾病的管理至关重要。
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