Academic Journal
View in EDS

Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study.

Bibliographic Details
Title: Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study.
Authors: Maitreyi Sahu, Cara J Bayer, D Allen Roberts, Heidi van Rooyen, Alastair van Heerden, Maryam Shahmanesh, Stephen Asiimwe, Kombi Sausi, Nsika Sithole, Roger Ying, Darcy W Rao, Meighan L Krows, Adrienne E Shapiro, Jared M Baeten, Connie Celum, Paul Revill, Ruanne V Barnabas
Source: PLOS Global Public Health, Vol 3, Iss 9, p e0000610 (2023)
Publisher Information: Public Library of Science (PLoS), 2023.
Publication Year: 2023
Collection: LCC:Public aspects of medicine
Subject Terms: Public aspects of medicine, RA1-1270
More Details: Community-based delivery and monitoring of antiretroviral therapy (ART) for HIV has the potential to increase viral suppression for individual- and population-level health benefits. However, the cost-effectiveness and budget impact are needed for public health policy. We used a mathematical model of HIV transmission in KwaZulu-Natal, South Africa, to estimate population prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 2020 to 2060 for two scenarios: 1) standard clinic-based HIV care and 2) five-yearly home testing campaigns with community ART for people not reached by clinic-based care. We parameterised model scenarios using observed community-based ART efficacy. Using a health system perspective, we evaluated incremental cost-effectiveness and net health benefits using a threshold of $750/DALY averted. In a sensitivity analysis, we varied the discount rate; time horizon; costs for clinic and community ART, hospitalisation, and testing; and the proportion of the population receiving community ART. Uncertainty ranges (URs) were estimated across 25 best-fitting parameter sets. By 2060, community ART following home testing averted 27.9% (UR: 24.3-31.5) of incident HIV infections, 27.8% (26.8-28.8) of HIV-related deaths, and 18.7% (17.9-19.7) of DALYs compared to standard of care. Adolescent girls and young women aged 15-24 years experienced the greatest reduction in incident HIV (30.7%, 27.1-34.7). In the first five years (2020-2024), community ART required an additional $44.9 million (35.8-50.1) annually, representing 14.3% (11.4-16.0) of the annual HIV budget. The cost per DALY averted was $102 (85-117) for community ART compared with standard of care. Providing six-monthly refills instead of quarterly refills further increased cost-effectiveness to $78.5 per DALY averted (62.9-92.8). Cost-effectiveness was robust to sensitivity analyses. In a high-prevalence setting, scale-up of decentralised ART dispensing and monitoring can provide large population health benefits and is cost-effective in preventing death and disability due to HIV.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2767-3375
Relation: https://doaj.org/toc/2767-3375
DOI: 10.1371/journal.pgph.0000610
Access URL: https://doaj.org/article/428a8f567ada4c41855f9b1723abae0a
Accession Number: edsdoj.428a8f567ada4c41855f9b1723abae0a
Database: Directory of Open Access Journals
FullText Text:
  Availability: 0
CustomLinks:
  – Url: https://resolver.ebsco.com/c/xy5jbn/result?sid=EBSCO:edsdoj&genre=article&issn=27673375&ISBN=&volume=3&issue=9&date=20230101&spage=e0000610&pages=&title=PLOS Global Public Health&atitle=Population%20health%20impact%2C%20cost-effectiveness%2C%20and%20affordability%20of%20community-based%20HIV%20treatment%20and%20monitoring%20in%20South%20Africa%3A%20A%20health%20economics%20modelling%20study.&aulast=Maitreyi%20Sahu&id=DOI:10.1371/journal.pgph.0000610
    Name: Full Text Finder (for New FTF UI) (s8985755)
    Category: fullText
    Text: Find It @ SCU Libraries
    MouseOverText: Find It @ SCU Libraries
  – Url: https://doaj.org/article/428a8f567ada4c41855f9b1723abae0a
    Name: EDS - DOAJ (s8985755)
    Category: fullText
    Text: View record from DOAJ
    MouseOverText: View record from DOAJ
Header DbId: edsdoj
DbLabel: Directory of Open Access Journals
An: edsdoj.428a8f567ada4c41855f9b1723abae0a
RelevancyScore: 961
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 960.976379394531
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study.
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Maitreyi+Sahu%22">Maitreyi Sahu</searchLink><br /><searchLink fieldCode="AR" term="%22Cara+J+Bayer%22">Cara J Bayer</searchLink><br /><searchLink fieldCode="AR" term="%22D+Allen+Roberts%22">D Allen Roberts</searchLink><br /><searchLink fieldCode="AR" term="%22Heidi+van+Rooyen%22">Heidi van Rooyen</searchLink><br /><searchLink fieldCode="AR" term="%22Alastair+van+Heerden%22">Alastair van Heerden</searchLink><br /><searchLink fieldCode="AR" term="%22Maryam+Shahmanesh%22">Maryam Shahmanesh</searchLink><br /><searchLink fieldCode="AR" term="%22Stephen+Asiimwe%22">Stephen Asiimwe</searchLink><br /><searchLink fieldCode="AR" term="%22Kombi+Sausi%22">Kombi Sausi</searchLink><br /><searchLink fieldCode="AR" term="%22Nsika+Sithole%22">Nsika Sithole</searchLink><br /><searchLink fieldCode="AR" term="%22Roger+Ying%22">Roger Ying</searchLink><br /><searchLink fieldCode="AR" term="%22Darcy+W+Rao%22">Darcy W Rao</searchLink><br /><searchLink fieldCode="AR" term="%22Meighan+L+Krows%22">Meighan L Krows</searchLink><br /><searchLink fieldCode="AR" term="%22Adrienne+E+Shapiro%22">Adrienne E Shapiro</searchLink><br /><searchLink fieldCode="AR" term="%22Jared+M+Baeten%22">Jared M Baeten</searchLink><br /><searchLink fieldCode="AR" term="%22Connie+Celum%22">Connie Celum</searchLink><br /><searchLink fieldCode="AR" term="%22Paul+Revill%22">Paul Revill</searchLink><br /><searchLink fieldCode="AR" term="%22Ruanne+V+Barnabas%22">Ruanne V Barnabas</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: PLOS Global Public Health, Vol 3, Iss 9, p e0000610 (2023)
– Name: Publisher
  Label: Publisher Information
  Group: PubInfo
  Data: Public Library of Science (PLoS), 2023.
– Name: DatePubCY
  Label: Publication Year
  Group: Date
  Data: 2023
– Name: Subset
  Label: Collection
  Group: HoldingsInfo
  Data: LCC:Public aspects of medicine
– Name: Subject
  Label: Subject Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Public+aspects+of+medicine%22">Public aspects of medicine</searchLink><br /><searchLink fieldCode="DE" term="%22RA1-1270%22">RA1-1270</searchLink>
– Name: Abstract
  Label: Description
  Group: Ab
  Data: Community-based delivery and monitoring of antiretroviral therapy (ART) for HIV has the potential to increase viral suppression for individual- and population-level health benefits. However, the cost-effectiveness and budget impact are needed for public health policy. We used a mathematical model of HIV transmission in KwaZulu-Natal, South Africa, to estimate population prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 2020 to 2060 for two scenarios: 1) standard clinic-based HIV care and 2) five-yearly home testing campaigns with community ART for people not reached by clinic-based care. We parameterised model scenarios using observed community-based ART efficacy. Using a health system perspective, we evaluated incremental cost-effectiveness and net health benefits using a threshold of $750/DALY averted. In a sensitivity analysis, we varied the discount rate; time horizon; costs for clinic and community ART, hospitalisation, and testing; and the proportion of the population receiving community ART. Uncertainty ranges (URs) were estimated across 25 best-fitting parameter sets. By 2060, community ART following home testing averted 27.9% (UR: 24.3-31.5) of incident HIV infections, 27.8% (26.8-28.8) of HIV-related deaths, and 18.7% (17.9-19.7) of DALYs compared to standard of care. Adolescent girls and young women aged 15-24 years experienced the greatest reduction in incident HIV (30.7%, 27.1-34.7). In the first five years (2020-2024), community ART required an additional $44.9 million (35.8-50.1) annually, representing 14.3% (11.4-16.0) of the annual HIV budget. The cost per DALY averted was $102 (85-117) for community ART compared with standard of care. Providing six-monthly refills instead of quarterly refills further increased cost-effectiveness to $78.5 per DALY averted (62.9-92.8). Cost-effectiveness was robust to sensitivity analyses. In a high-prevalence setting, scale-up of decentralised ART dispensing and monitoring can provide large population health benefits and is cost-effective in preventing death and disability due to HIV.
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: article
– Name: Format
  Label: File Description
  Group: SrcInfo
  Data: electronic resource
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 2767-3375
– Name: NoteTitleSource
  Label: Relation
  Group: SrcInfo
  Data: https://doaj.org/toc/2767-3375
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1371/journal.pgph.0000610
– Name: URL
  Label: Access URL
  Group: URL
  Data: <link linkTarget="URL" linkTerm="https://doaj.org/article/428a8f567ada4c41855f9b1723abae0a" linkWindow="_blank">https://doaj.org/article/428a8f567ada4c41855f9b1723abae0a</link>
– Name: AN
  Label: Accession Number
  Group: ID
  Data: edsdoj.428a8f567ada4c41855f9b1723abae0a
PLink https://login.libproxy.scu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&scope=site&db=edsdoj&AN=edsdoj.428a8f567ada4c41855f9b1723abae0a
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1371/journal.pgph.0000610
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        StartPage: e0000610
    Subjects:
      – SubjectFull: Public aspects of medicine
        Type: general
      – SubjectFull: RA1-1270
        Type: general
    Titles:
      – TitleFull: Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Maitreyi Sahu
      – PersonEntity:
          Name:
            NameFull: Cara J Bayer
      – PersonEntity:
          Name:
            NameFull: D Allen Roberts
      – PersonEntity:
          Name:
            NameFull: Heidi van Rooyen
      – PersonEntity:
          Name:
            NameFull: Alastair van Heerden
      – PersonEntity:
          Name:
            NameFull: Maryam Shahmanesh
      – PersonEntity:
          Name:
            NameFull: Stephen Asiimwe
      – PersonEntity:
          Name:
            NameFull: Kombi Sausi
      – PersonEntity:
          Name:
            NameFull: Nsika Sithole
      – PersonEntity:
          Name:
            NameFull: Roger Ying
      – PersonEntity:
          Name:
            NameFull: Darcy W Rao
      – PersonEntity:
          Name:
            NameFull: Meighan L Krows
      – PersonEntity:
          Name:
            NameFull: Adrienne E Shapiro
      – PersonEntity:
          Name:
            NameFull: Jared M Baeten
      – PersonEntity:
          Name:
            NameFull: Connie Celum
      – PersonEntity:
          Name:
            NameFull: Paul Revill
      – PersonEntity:
          Name:
            NameFull: Ruanne V Barnabas
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2023
          Identifiers:
            – Type: issn-print
              Value: 27673375
          Numbering:
            – Type: volume
              Value: 3
            – Type: issue
              Value: 9
          Titles:
            – TitleFull: PLOS Global Public Health
              Type: main
ResultId 1