Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa

A health economics modelling study

Bibliographic Data

ID19594350
AuthorsMaitreyi Sahu (0000-0002-1593-0193, University of Washington, corresponding author), Cara J Bayer (University of Washington, corresponding author), D Allen Roberts (0000-0003-3660-6330, University of Washington, corresponding author), Heidi Van Rooyen (0000-0002-6502-6098, Human Sciences Research Council, corresponding author), Alastair Van Heerden (0000-0003-2530-6885, Human Sciences Research Council, corresponding author), M Shahmanesh (0000-0001-7129-8535, Africa Health Research Institute, corresponding author), Stephen Asiimwe (0000-0001-6440-0036, Integrated Community Based Initiatives, corresponding author), Kombi Sausi (Human Sciences Research Council, corresponding author), Nsika Sithole (0000-0003-2090-3453, Africa Health Research Institute, corresponding author), Roger Ying (0000-0002-0380-3197, Yale University, corresponding author), Darcy W Rao (0000-0003-0058-8513, University of Washington, corresponding author), Meighan Krows (0000-0003-0321-9203, University of Washington, corresponding author), Adrienne E Shapiro (0000-0002-3106-1258, University of Washington, corresponding author), Jared M Baeten (0000-0001-8242-8438, University of Washington, corresponding author), Connie Celum (0000-0002-8813-3419, University of Washington, corresponding author), Paul Revill (0000-0001-8632-0600, University of York, corresponding author), Ruanne V Barnabas (0000-0002-1793-6003, Harvard University, corresponding author)
EditorsSiyan Yi (0000-0002-3045-5386)
Year2023
Volume3
Issue9
Pagese0000610
Publication date2023-09-05
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0000610
PMID37669249
OpenAlexW4386461891
LanguageEN
References cited23

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

Community health · Cost effectiveness · Cost-effectiveness analysis · Cost–benefit analysis · Economic evaluation · Economic growth · Economics · Environmental health · Health care · Health economics · Population · Population health · Public health · Quality-adjusted life year · Adolescent Sexual and Reproductive Health · Demography · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Nursing · Gerontology