Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness

 

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dc.contributor.author Bassett, Ingrid V en_ZA
dc.contributor.author Govindasamy, Darshini en_ZA
dc.contributor.author Erlwanger, Alison S en_ZA
dc.contributor.author Hyle, Emily P en_ZA
dc.contributor.author Kranzer, Katharina en_ZA
dc.contributor.author van Schaik, Nienke en_ZA
dc.contributor.author Noubary, Farzad en_ZA
dc.contributor.author Paltiel, A David en_ZA
dc.contributor.author Wood, Robin en_ZA
dc.contributor.author Walensky, Rochelle P en_ZA
dc.date.accessioned 2015-11-23T12:25:28Z
dc.date.available 2015-11-23T12:25:28Z
dc.date.issued 2014 en_ZA
dc.identifier.citation Bassett, I. V., Govindasamy, D., Erlwanger, A. S., Hyle, E. P., Kranzer, K., van Schaik, N., ... & Freedberg, K. A. (2013). Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness. PloS one, 9(1), e85197-e85197. doi:10.1371/journal.pone.0085197 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15269
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0085197
dc.description.abstract BACKGROUND: Mobile HIV screening may facilitate early HIV diagnosis. Our objective was to examine the cost-effectiveness of adding a mobile screening unit to current medical facility-based HIV testing in Cape Town, South Africa. Methods and FINDINGS: We used the Cost Effectiveness of Preventing AIDS Complications International (CEPAC-I) computer simulation model to evaluate two HIV screening strategies in Cape Town: 1) medical facility-based testing (the current standard of care) and 2) addition of a mobile HIV-testing unit intervention in the same community. Baseline input parameters were derived from a Cape Town-based mobile unit that tested 18,870 individuals over 2 years: prevalence of previously undiagnosed HIV (6.6%), mean CD4 count at diagnosis (males 423/µL, females 516/µL), CD4 count-dependent linkage to care rates (males 31%-58%, females 49%-58%), mobile unit intervention cost (includes acquisition, operation and HIV test costs, $29.30 per negative result and $31.30 per positive result). We conducted extensive sensitivity analyses to evaluate input uncertainty. Model outcomes included site of HIV diagnosis, life expectancy, medical costs, and the incremental cost-effectiveness ratio (ICER) of the intervention compared to medical facility-based testing. We considered the intervention to be "very cost-effective" when the ICER was less than South Africa's annual per capita Gross Domestic Product (GDP) ($8,200 in 2012). We projected that, with medical facility-based testing, the discounted (undiscounted) HIV-infected population life expectancy was 132.2 (197.7) months; this increased to 140.7 (211.7) months with the addition of the mobile unit. The ICER for the mobile unit was $2,400/year of life saved (YLS). Results were most sensitive to the previously undiagnosed HIV prevalence, linkage to care rates, and frequency of HIV testing at medical facilities. CONCLUSION: The addition of mobile HIV screening to current testing programs can improve survival and be very cost-effective in South Africa and other resource-limited settings, and should be a priority. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other HIV en_ZA
dc.subject.other HIV diagnosis and management en_ZA
dc.subject.other Cost-effectiveness analysis en_ZA
dc.subject.other South Africa en_ZA
dc.subject.other Antiretroviral therapy en_ZA
dc.subject.other Life expectancy en_ZA
dc.subject.other Economic analysis en_ZA
dc.subject.other HIV prevention en_ZA
dc.title Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2014 Bassett et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Desmond Tutu HIV Centre en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Bassett, I. V., Govindasamy, D., Erlwanger, A. S., Hyle, E. P., Kranzer, K., van Schaik, N., ... Walensky, R. P. (2014). Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness. <i>PLoS One</i>, http://hdl.handle.net/11427/15269 en_ZA
dc.identifier.chicagocitation Bassett, Ingrid V, Darshini Govindasamy, Alison S Erlwanger, Emily P Hyle, Katharina Kranzer, Nienke van Schaik, Farzad Noubary, A David Paltiel, Robin Wood, and Rochelle P Walensky "Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness." <i>PLoS One</i> (2014) http://hdl.handle.net/11427/15269 en_ZA
dc.identifier.vancouvercitation Bassett IV, Govindasamy D, Erlwanger AS, Hyle EP, Kranzer K, van Schaik N, et al. Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness. PLoS One. 2014; http://hdl.handle.net/11427/15269. en_ZA
dc.identifier.ris TY - Journal Article AU - Bassett, Ingrid V AU - Govindasamy, Darshini AU - Erlwanger, Alison S AU - Hyle, Emily P AU - Kranzer, Katharina AU - van Schaik, Nienke AU - Noubary, Farzad AU - Paltiel, A David AU - Wood, Robin AU - Walensky, Rochelle P AB - BACKGROUND: Mobile HIV screening may facilitate early HIV diagnosis. Our objective was to examine the cost-effectiveness of adding a mobile screening unit to current medical facility-based HIV testing in Cape Town, South Africa. Methods and FINDINGS: We used the Cost Effectiveness of Preventing AIDS Complications International (CEPAC-I) computer simulation model to evaluate two HIV screening strategies in Cape Town: 1) medical facility-based testing (the current standard of care) and 2) addition of a mobile HIV-testing unit intervention in the same community. Baseline input parameters were derived from a Cape Town-based mobile unit that tested 18,870 individuals over 2 years: prevalence of previously undiagnosed HIV (6.6%), mean CD4 count at diagnosis (males 423/µL, females 516/µL), CD4 count-dependent linkage to care rates (males 31%-58%, females 49%-58%), mobile unit intervention cost (includes acquisition, operation and HIV test costs, $29.30 per negative result and $31.30 per positive result). We conducted extensive sensitivity analyses to evaluate input uncertainty. Model outcomes included site of HIV diagnosis, life expectancy, medical costs, and the incremental cost-effectiveness ratio (ICER) of the intervention compared to medical facility-based testing. We considered the intervention to be "very cost-effective" when the ICER was less than South Africa's annual per capita Gross Domestic Product (GDP) ($8,200 in 2012). We projected that, with medical facility-based testing, the discounted (undiscounted) HIV-infected population life expectancy was 132.2 (197.7) months; this increased to 140.7 (211.7) months with the addition of the mobile unit. The ICER for the mobile unit was $2,400/year of life saved (YLS). Results were most sensitive to the previously undiagnosed HIV prevalence, linkage to care rates, and frequency of HIV testing at medical facilities. CONCLUSION: The addition of mobile HIV screening to current testing programs can improve survival and be very cost-effective in South Africa and other resource-limited settings, and should be a priority. DA - 2014 DB - OpenUCT DO - 10.1371/journal.pone.0085197 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness TI - Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness UR - http://hdl.handle.net/11427/15269 ER - en_ZA


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.