期刊
CLINICAL INFECTIOUS DISEASES
卷 67, 期 5, 页码 719-726出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciy173
关键词
HIV; voluntary community testing; cascade of care; cost-effectiveness; Kenya
资金
- Medecins Sans Frontieres (MSF) France
- Harvard University Center for AIDS Research - National Institutes of Health [P30 AI060354]
- National Institutes of Health: National Institute of Allergy and Infectious Diseases
- National Institutes of Health: National Cancer Institute
- National Institutes of Health: National Institute of Child Health and Human Development
- National Institutes of Health: National Institute of Dental and Craniofacial Research
- National Institutes of Health: National Heart, Lung, and Blood Institute
- National Institutes of Health: National Institute on Drug Abuse
- National Institutes of Health: National Institute of Mental Health
- National Institutes of Health: National Institute on Aging
- National Institutes of Health: National Institute of Diabetes and Digestive and Kidney Diseases
- National Institutes of Health: National Institute of General Medical Science
- National Institutes of Health: National Institute on Minority Health and Health Disparities
- National Institutes of Health: Fogarty International Center
- National Institutes of Health: Office of AIDS Research
Background. In southwest Kenya, the prevalence of human immunodeficiency virus (HIV) infection is about 25%. Medecins Sans Frontieres has implemented a voluntary community testing (VCT) program, with linkage to care and retention interventions, to achieve the Joint United Nations Program on HIV and AIDS (UNAIDS) 90-90-90 targets by 2017. We assessed the effectiveness and cost-effectiveness of these interventions. Methods. We developed a time-discrete, dynamic microsimulation model to project HIV incidence over time in the adult population in Kenya. We modeled 4 strategies: VCT, VCT-plus-linkage to care, a retention intervention, and all 3 interventions combined. Effectiveness outcomes included HIV incidence, years of life saved (YLS), cost (2014 (sic)), and cost-effectiveness. We performed sensitivity analyses on key model parameters. Results. With current care, the projected HIV incidence for 2032 was 1.51/100 person-years (PY); the retention and combined interventions decreased incidence to 1.03/100 PY and 0.75/100 PY, respectively. For 100 000 individuals, the retention intervention had an incremental cost-effectiveness ratio (ICER) of (sic)130/YLS compared with current care; the combined intervention incremental cost-effectiveness ratio was (sic)370/YLS compared with the retention intervention. VCT and VCT-plus-linkage interventions cost more and saved fewer life-years than the retention and combined interventions. Baseline HIV prevalence had the greatest impact on the results. Conclusions. Interventions targeting VCT, linkage to care, and retention would decrease HIV incidence rate over 15 years in rural Kenya if planned targets are achieved. These interventions together would be more effective and cost-effective than targeting a single stage of the HIV care cascade.
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