Faculty of Management, Department of Industrial Engineering, Istanbul Technical University, Istanbul, Turkey.
Nar Innovative Solutions, Istanbul, Turkey.
PLoS One. 2023 Jun 30;18(6):e0286254. doi: 10.1371/journal.pone.0286254. eCollection 2023.
This study aimed to determine HIV incidence and prevalence in Turkey and to estimate the cost-effectiveness of improving testing and diagnosis in the next 20 years.
HIV incidence in Turkey has been rapidly increasing in the last decade with a particularly high rate of infection for younger populations, which underscores the urgent need for a robust prevention program and improved testing capacity for HIV.
We developed a dynamic compartmental model of HIV transmission and progression among the Turkish population aged 15-64 and assessed the effect of improving testing and diagnosis. The model generated the number of new HIV cases by transmission risk and CD4 level, HIV diagnoses, HIV prevalence, continuum of care, the number of HIV-related deaths, and the expected number of infections prevented from 2020 to 2040. We also explored the cost impact of HIV and the cost-effectiveness of improving testing and diagnosis.
Under the base case scenario, the model estimated an HIV incidence of 13,462 cases in 2020, with 63% undiagnosed. The number of infections was estimated to increase by 27% by 2040, with HIV incidence in 2040 reaching 376,889 and HIV prevalence 2,414,965 cases. Improving testing and diagnosis to 50%, 70%, and 90%, would prevent 782,789, 2,059,399, and 2,336,564 infections-32%, 85%, and 97% reduction in 20 years, respectively. Improved testing and diagnosis would reduce spending between $1.8 and $8.8 billion.
In the case of no improvement in the current continuum of care, HIV incidence and prevalence will significantly increase over the next 20 years, placing a significant burden on the Turkish healthcare system. However, improving testing and diagnosis could substantially reduce the number of infections, ameliorating the public health and disease burden aspects.
本研究旨在确定土耳其的艾滋病毒发病率和流行率，并估计在未来 20 年内提高检测和诊断水平的成本效益。
在过去十年中，土耳其的艾滋病毒发病率迅速上升，年轻人群的感染率尤其高，这突显了迫切需要一个强有力的预防计划和提高艾滋病毒检测能力。
我们开发了一个针对土耳其 15-64 岁人群的艾滋病毒传播和进展的动态房室模型，并评估了改善检测和诊断的效果。该模型根据传播风险和 CD4 水平生成新的艾滋病毒病例数、艾滋病毒诊断数、艾滋病毒流行率、护理连续体、艾滋病毒相关死亡人数以及预计可预防的感染人数，从 2020 年到 2040 年。我们还探讨了艾滋病毒的成本影响和改善检测和诊断的成本效益。
在基本情况下，模型估计 2020 年艾滋病毒发病率为 13462 例，其中 63%未被诊断。到 2040 年，感染人数预计将增加 27%，届时艾滋病毒发病率将达到 376889 例，艾滋病毒流行率为 2414965 例。将检测和诊断率提高到 50%、70%和 90%，将分别预防 782789、2059399 和 2336564 例感染，即 20 年内减少 32%、85%和 97%。改进检测和诊断将减少 18 亿至 88 亿美元的支出。
如果目前的护理连续体没有得到改善，艾滋病毒的发病率和流行率将在未来 20 年内显著增加，这将给土耳其的医疗保健系统带来巨大负担。然而，提高检测和诊断水平可以大大减少感染人数，从而改善公共卫生和疾病负担方面的情况。
