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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Clinical impact and cost-effectiveness of cotrimoxazole prophylaxis in patients with HIV/AIDS in Côte d'Ivoire: A trial-based analysis
AIDS, Volume 19, No. 12, Year 2005
Notification
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Description
Background: In 2000, WHO/UNAIDS recommended co-trimoxazole prophylaxis for persons at early stages of HIV infection (WHO stage ≥ 2) in sub-Saharan Africa. Objective: To assess the cost-effectiveness of alternative strategies for initiation of cotrimoxazole in Côte d'Ivoire. Design: Cost-effectiveness analysis with an HIV simulation model using clinical and cost data from a randomized trial of co-trimoxazole in HIV-infected adults. Methods: The study included HIV-infected patients in Côte d'Ivoire, with median age 33 years. Thirty-four percent were classified as WHO stage 2, 59% as stage 3, and 7% as stage 4. The mean CD4 cell count was 331 × 106 cells/l. The interventions were no prophylaxis, clinical criteria-based co-trimoxazole initiation (early: WHO stage ≥ 2; late: WHO stage ≥ 3), CD4-based co-trimoxazole initiation (< 500, < 200, < 50 × 10 6 CD4 cells/l). The outcome measures were life expectancy, lifetime costs, and incremental cost-effectiveness. Results: The most effective strategy, initiation of co-trimoxazole prophylaxis at WHO stage ≥ 2, increased undiscounted life expectancy by 5.2 months, discounted life expectancy by 4.4 months, and lifetime costs by US$ 60, compared with no prophylaxis. Delaying prophylaxis initiation until WHO stage ≥ 3 was less costly and less effective. All CD4-based strategies were dominated. The incremental cost-effectiveness of early versus late co-trimoxazole prophylaxis initiation was US$ 200/year of life gained. Results were stable despite wide variations in plausible assumptions about bacterial resistance and the prophylaxis efficacy on co-trimoxazole-resistant strains. Conclusions: For HIV-infected adults in Côte d'Ivoire, co-trimoxazole prophylaxis is reasonably cost-effective and most effective if initiated when WHO stage ≥ 2. Early co-trimoxazole prophylaxis will prevent complications prior to antiretroviral therapy initiation and should be considered an essential component of care for early HIV in sub-Saharan Africa. © 2005 Lippincott Williams & Wilkins.
Authors & Co-Authors
Yazdanpanah, Yazdan
France, Tourcoing
Centre Hospitalier de Tourcoing
France, Paris
Cnrs Centre National de la Recherche Scientifique
Losina, Elena
United States, Boston
School of Public Health
Anglaret, Xavier
France, Paris
Inserm
Cote D'ivoire, Abidjan
Programme Pac-ci
Goldie, Sue J.
United States, Boston
Harvard T.h. Chan School of Public Health
Walensky, Rochelle P.
United States, Boston
Massachusetts General Hospital
Weinstein, Milton C.
United States, Boston
Harvard T.h. Chan School of Public Health
Touré, Siaka
Cote D'ivoire, Abidjan
Programme Pac-ci
Hsu, Heather E.
United States, Boston
Massachusetts General Hospital
Kaplan, Jonathan E.
United States, Atlanta
Centers for Disease Control and Prevention
Freedberg, Kenneth A.
United States, Boston
School of Public Health
United States, Boston
Massachusetts General Hospital
United States, Boston
Harvard T.h. Chan School of Public Health
Statistics
Citations: 89
Authors: 10
Affiliations: 8
Identifiers
Doi:
10.1097/01.aids.0000180101.80888.c6
Research Areas
Infectious Diseases
Study Locations
Ivory Coast