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

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dc.contributor.authorBassett, Ingrid Ven_ZA
dc.contributor.authorGovindasamy, Darshinien_ZA
dc.contributor.authorErlwanger, Alison Sen_ZA
dc.contributor.authorHyle, Emily Pen_ZA
dc.contributor.authorKranzer, Katharinaen_ZA
dc.contributor.authorvan Schaik, Nienkeen_ZA
dc.contributor.authorNoubary, Farzaden_ZA
dc.contributor.authorPaltiel, A Daviden_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorWalensky, Rochelle Pen_ZA
dc.date.accessioned2015-11-23T12:25:28Z
dc.date.available2015-11-23T12:25:28Z
dc.date.issued2014en_ZA
dc.description.abstractBACKGROUND: 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.identifier.apacitationBassett, 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/11427/15269en_ZA
dc.identifier.chicagocitationBassett, 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/11427/15269en_ZA
dc.identifier.citationBassett, 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.0085197en_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
dc.identifier.urihttp://hdl.handle.net/11427/15269
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0085197
dc.identifier.vancouvercitationBassett 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.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2014 Bassett et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherCost-effectiveness analysisen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherLife expectancyen_ZA
dc.subject.otherEconomic analysisen_ZA
dc.subject.otherHIV preventionen_ZA
dc.titleMobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectivenessen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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