Department of Epidemiology.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
AIDS. 2021 Feb 2;35(2):287-297. doi: 10.1097/QAD.0000000000002739.
Early infant diagnosis of HIV (EID) improves child survival through earlier initiation of antiretroviral therapy (ART). In many settings, ART initiation is hindered by delays in testing performed in centralized labs. Point-of-care (PoC) platforms offer opportunities to improve the timeliness of ART initiation.
We used a mathematical model to estimate the costs and performance of on-site PoC testing using three platforms (m-PIMA, GeneXpert IV, and GeneXpert Edge) compared with the standard of care (SoC). Primary outcomes included ART initiation within 60 days of sample collection, HIV-related mortality before ART initiation, and incremental cost-effectiveness ratios (ICERs).
PoC testing significantly increased ART initiation within 60 days (from 19% with SoC to 82-84% with PoC) and decreased HIV-related mortality (from 23% with SoC to 5% with PoC). ART initiation and mortality were similar across PoC platforms. When only used for EID and with high coverage of prevention of mother-to-child transmission (PMTCT) programs, ICERs for PoC testing compared with the SoC ranged from $430 to $1097 per additional infant on ART within 60 days and from $1527 to $3888 per death averted. PoC-based testing was more cost-effective in settings with lower PMTCT coverage, greater delays in the SoC, and when PoC instruments could be integrated with other disease programs.
Our findings illustrate that PoC platforms can dramatically improve the timeliness of EID and linkage to HIV care. The cost-effectiveness of PoC platforms depends on the cost of PoC testing, existing access to diagnostic testing, and the ability to integrate PoC testing with non-EID programs.
早期婴儿艾滋病毒诊断（EID）通过更早地开始抗逆转录病毒治疗（ART）来提高儿童的存活率。在许多环境中，由于在集中实验室进行的检测延迟，ART 的启动受到阻碍。即时检测（PoC）平台提供了改善 ART 启动及时性的机会。
我们使用数学模型来评估使用三种平台（m-PIMA、GeneXpert IV 和 GeneXpert Edge）进行现场 PoC 检测与标准护理（SoC）相比的成本和性能。主要结果包括在样本采集后 60 天内开始 ART、开始 ART 前的 HIV 相关死亡率以及增量成本效益比（ICER）。
PoC 检测显著增加了 60 天内开始 ART 的比例（从 SoC 的 19%增加到 PoC 的 82-84%），并降低了 HIV 相关死亡率（从 SoC 的 23%降低到 PoC 的 5%）。PoC 平台的 ART 启动和死亡率相似。当仅用于 EID 并且预防母婴传播（PMTCT）计划的覆盖率较高时，与 SoC 相比，PoC 检测的 ICER 在 60 天内每增加一名接受 ART 的婴儿在 430 美元至 1097 美元之间，每避免一次死亡在 1527 美元至 3888 美元之间。在 PMTCT 覆盖率较低、SoC 延迟较大以及 PoC 仪器可以与其他疾病项目集成的情况下，基于 PoC 的检测更具成本效益。
我们的研究结果表明，PoC 平台可以极大地提高 EID 的及时性和与 HIV 护理的联系。PoC 平台的成本效益取决于 PoC 检测的成本、现有的诊断检测获取情况以及将 PoC 检测与非 EID 项目集成的能力。
