dc.date.accessioned |
2023-11-01T10:01:07Z |
|
dc.date.available |
2023-11-01T10:01:07Z |
|
dc.date.issued |
2023-11-01 |
en |
dc.identifier.uri |
http://hdl.handle.net/20.500.11910/22686
|
|
dc.description.abstract |
Community-based delivery and monitoring of antiretroviral therapy (ART) for HIV has the potential to increase viral suppression for individual- and population-level health benefits. However, the cost-effectiveness and budget impact are needed for public health policy. We used a mathematical model of HIV transmission in KwaZulu-Natal, South Africa, to estimate population prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 2020 to 2060 for two scenarios: 1) standard clinic-based HIV care and 2) five-yearly home testing campaigns with community ART for people not reached by clinic-based care. We parameterised model scenarios using observed community-based ART efficacy. Using a health system perspective, we evaluated incremental cost-effectiveness and net health benefits using a threshold of $750/DALY averted. In a sensitivity analysis, we varied the discount rate; time horizon; costs for clinic and community ART, hospitalisation, and testing; and the proportion of the population receiving community ART. Uncertainty ranges (URs) were estimated across 25 best-fitting parameter sets. By 2060, community ART following home testing averted 27.9% (UR: 24.3-31.5) of incident HIV infections, 27.8% (26.8-28.8) of HIV-related deaths, and 18.7% (17.9-19.7) of DALYs compared to standard of care. Adolescent girls and young women aged 15-24 years experienced the greatest reduction in incident HIV (30.7%, 27.1-34.7). In the first five years (2020-2024), community ART required an additional $44.9 million (35.8-50.1) annually, representing 14.3% (11.4-16.0) of the annual HIV budget. The cost per DALY averted was $102 (85-117) for community ART compared with standard of care. Providing six-monthly refills instead of quarterly refills further increased cost-effectiveness to $78.5 per DALY averted (62.9-92.8). Cost-effectiveness was robust to sensitivity analyses. In a high-prevalence setting, scale-up of decentralised ART dispensing and monitoring can provide large population health benefits and is cost-effective in preventing death and disability due to HIV. |
en |
dc.format.medium |
Print |
en |
dc.subject |
POPULATION STUDIES |
en |
dc.subject |
HEALTH |
en |
dc.subject |
HIV/AIDS |
en |
dc.subject |
HIV/AIDS TREATMENT |
en |
dc.title |
Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: a health economics modelling study |
en |
dc.type |
Journal Article |
en |
dc.description.version |
Y |
en |
dc.ProjectNumber |
PUAWAA |
en |
dc.Volume |
September |
en |
dc.BudgetYear |
2023/24 |
en |
dc.ResearchGroup |
Public Health, Societies and Belonging |
en |
dc.ResearchGroup |
Developmental, Capable and Ethical State |
en |
dc.ResearchGroup |
Impact Centre |
en |
dc.SourceTitle |
PLOS Global Public Health |
en |
dc.ArchiveNumber |
9814104 |
en |
dc.URL |
http://ktree.hsrc.ac.za/doc_read_all.php?docid=27803 |
en |
dc.PageNumber |
Online |
en |
dc.outputnumber |
14761 |
en |
dc.bibliographictitle |
Sahu, M., Bayer, C.J., Roberts, D.A., Van Rooyen, H., Van Heerden, A., Shahmanesh, M., Asiimwe, S., Sausi, K., Sithole, N., Ying, R., Rao, D.W., Krows, M.L., Shapiro, A.E., Baeten, J.M., Celum, C., Revill, P. & Barnabas, R.V. (2023) Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: a health economics modelling study. PLOS Global Public Health. September:Online. |
en |
dc.publicationyear |
2023 |
en |
dc.contributor.author1 |
Sahu, M. |
en |
dc.contributor.author2 |
Bayer, C.J. |
en |
dc.contributor.author3 |
Roberts, D.A. |
en |
dc.contributor.author4 |
Van Rooyen, H. |
en |
dc.contributor.author5 |
Van Heerden, A. |
en |
dc.contributor.author6 |
Shahmanesh, M. |
en |
dc.contributor.author7 |
Asiimwe, S. |
en |
dc.contributor.author8 |
Sausi, K. |
en |
dc.contributor.author9 |
Sithole, N. |
en |
dc.contributor.author10 |
Ying, R. |
en |
dc.contributor.author11 |
Rao, D.W. |
en |
dc.contributor.author12 |
Krows, M.L. |
en |
dc.contributor.author13 |
Shapiro, A.E. |
en |
dc.contributor.author14 |
Baeten, J.M. |
en |
dc.contributor.author15 |
Celum, C. |
en |
dc.contributor.author16 |
Revill, P. |
en |
dc.contributor.author17 |
Barnabas, R.V. |
en |