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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Mobile HIV screening in Cape Town, South Africa: Clinical impact, cost and cost-effectiveness
PLoS ONE, Volume 9, No. 1, Article e85197, Year 2014
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Description
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 costeffective in South Africa and other resource-limited settings, and should be a priority. © 2014 Bassett et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3898963/bin/pone.0085197.s001.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3898963/bin/pone.0085197.s002.tiff
https://efashare.b-cdn.net/share/pmc/articles/PMC3898963/bin/pone.0085197.s003.tif
Authors & Co-Authors
Bassett, Ingrid V.
Unknown Affiliation
Govindasamy, Darshini
Unknown Affiliation
Erlwanger, Alison S.
Unknown Affiliation
Hyle, Emily P.
Unknown Affiliation
Kranzer, Katharina A.
Unknown Affiliation
van Schaik, N.
Unknown Affiliation
Noubary, Farzad
Unknown Affiliation
Paltiel, A. David
Unknown Affiliation
Wood, Robin Y.
Unknown Affiliation
Walensky, Rochelle P.
Unknown Affiliation
Losina, Elena
Unknown Affiliation
Bekker, Linda-Gail Gail
Unknown Affiliation
Freedberg, Kenneth A.
Unknown Affiliation
Statistics
Citations: 60
Authors: 13
Affiliations: 12
Identifiers
Doi:
10.1371/journal.pone.0085197
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
South Africa
Participants Gender
Female