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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Assisted partner notification services are cost-effective for decreasing HIV burden in western Kenya
AIDS, Volume 32, No. 2, Year 2018
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Description
Background: Assisted partner services (aPS) or provider notification for sexual partners of persons diagnosed HIV positive can increase HIV testing and linkage in Sub-Saharan Africa and is a high yield strategy to identify HIV-positive persons. However, its cost-effectiveness is not well evaluated. Methods: Using effectiveness and cost data from an aPS trial in Kenya, we parameterized an individual-based, dynamic HIV transmission model. We estimated costs for both a program scenario and a task-shifting scenario using community health workers to conduct the intervention. We simulated 200 cohorts of 500 000 individuals and projected the health and economic effects of scaling up aPS in a region of western Kenya (formerly Nyanza Province). Findings: Over a 10-year time horizon with universal antiretroviral therapy (ART) initiation, implementing aPS in western Kenya was projected to reach 12.5% of the population and reduce incident HIV infections by 3.7%. In sexual partners receiving aPS, HIV-related deaths were reduced by 13.7%. The incremental cost-effectiveness ratio of aPS was 1094 (US dollars) (90% model variability 823-1619) and 833 (90% model variability 628-1224) per disability-Adjusted life year averted under the program and task-shifting scenario, respectively. The incremental cost-effectiveness ratios for both scenarios fall below Kenya's gross domestic product per capita (1358) and are therefore considered very cost-effective. Results were robust to varying healthcare costs, linkage to care rates, partner concurrency rates, and ART eligibility thresholds (≤350 cells/μl, ≤500 cells/μl, and universal ART). Interpretation: APS is cost-effective for reducing HIV-related morbidity and mortality in western Kenya and similar settings. Task shifting can increase program affordability. ©
Authors & Co-Authors
Sharma, Monisha
United States, Seattle
University of Washington
Smith, Jennifer A.
United Kingdom, London
Imperial College London
Farquhar, Carey
United States, Seattle
University of Washington
Ying, Roger
United States, New York
Weill Cornell Medicine
Cherutich, Peter K.
Kenya, Nairobi
Ministry of Health Nairobi
Golden, Matthew Robert
United States, Seattle
University of Washington
Wamuti, Beatrice Muthoni
Kenya, Nairobi
Kenyatta National Hospital
Bukusi, David E.
Kenya, Nairobi
Kenyatta National Hospital
Spiegel, Hans M.L.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Barnabas, Ruanne Vanessa
United States, Seattle
University of Washington
Statistics
Citations: 47
Authors: 10
Affiliations: 6
Identifiers
Doi:
10.1097/QAD.0000000000001697
e-ISSN:
14735571
Research Areas
Disability
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Study Locations
Kenya