Testing strategies to detect acute and prevalent HIV infection in adult outpatients seeking healthcare for symptoms compatible with acute HIV infection in Kenya: a cost-effectiveness analysis. Issue 9 (29th September 2022)

• Record Type: Journal Article
• Authors: Babigumira, Joseph B; Agutu, Clara A; Hamilton, Deven T; van der Elst, Elise; Hassan, Amin; Gichuru, Evanson; Mugo, Peter Mwangi; Farquhar, Carey; Ndung'u, Thumbi; Sirengo, Martin; Chege, Wairimu; Goodreau, Steven M; Sanders, Eduard J; M Graham, Susan
• Is Part Of: BMJ open. Volume 12:Issue 9(2022)
• Publication Date: 2022-09-29
• Subjects: Health economics -- Health policy -- HIV & AIDS -- HEALTH ECONOMICS; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2021-058636
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Background: Detection of acute and prevalent HIV infection using point-of-care nucleic acid amplification testing (POC-NAAT) among outpatients with symptoms compatible with acute HIV is critical to HIV prevention, but it is not clear if it is cost-effective compared with existing HIV testing strategies. Methods: We developed and parametrised a decision tree to compare the cost-effectiveness of (1) provider-initiated testing and counselling (PITC) using rapid tests, the standard of care; (2) scaled-up provider-initiated testing and counselling (SU-PITC) in which all patients were tested with rapid tests unless they opted out; and (3) opt-out testing and counselling using POC-NAAT, which detects both acute and prevalent infection. The model-based analysis used data from the Tambua Mapema Plus randomised controlled trial of a POC-NAAT intervention in Kenya, supplemented with results from a stochastic, agent-based network model of HIV-1 transmission and data from published literature. The analysis was conducted from the perspective of the Kenyan government using a primary outcome of cost per disability-adjusted life-year (DALY) averted over a 10-year time horizon. Results: After analysing the decision-analytical model, the average per patient cost of POC-NAAT was $214.9 compared with $173.6 for SU-PITC and $47.3 for PITC. The mean DALYs accumulated per patient for POC-NAAT were 0.160 compared with 0.176 for SU-PITC and 0.214 for PITC. In the incremental analysis, SU-PITC was eliminated due to extended dominance, and the incremental cost-effectiveness ratio (ICER) comparing POC-NAAT to PITC was $3098 per DALY averted. The ICER was sensitive to disability weights for HIV/AIDS and the costs of antiretroviral therapy. Conclusion: POC-NAAT offered to adult outpatients in Kenya who present for care with symptoms compatible with AHI is cost-effective and should be considered for inclusion as the standard of HIV testing in this population. Trial registration number: Tambua Mapema ("Discover Early") Plus study (NCT03508908 ) conducted in Kenya (2017–2020) i.e., Post-results.