The value of confirmatory testing in early infant HIV diagnosis programmes in South Africa: A cost-effectiveness analysis

Autor: Valériane Leroy, Andrea L. Ciaranello, Martina Penazzato, Kenneth A. Freedberg, Lorna Dunning, Divya Mallampati, Taige Hou, Elaine J. Abrams, Rochelle P. Walensky, Rachel L. MacLean, Landon Myer, Jordan A. Francke
Jazyk: angličtina
Rok vydání: 2017
Předmět:
RNA viruses
0301 basic medicine
Pediatrics
Cost-Benefit Analysis
lcsh:Medicine
HIV Infections
Pathology and Laboratory Medicine
Geographical locations
South Africa
Families
0302 clinical medicine
Immunodeficiency Viruses
Pregnancy
Epidemiology
Health care
Medicine and Health Sciences
Public and Occupational Health
030212 general & internal medicine
Medical diagnosis
Children
HIV diagnosis and management
Health Care Costs
General Medicine
Cost-effectiveness analysis
Vaccination and Immunization
3. Good health
Medical Microbiology
Viral Pathogens
Viruses
Infectious diseases
Female
Pathogens
Pediatric Infections
Infants
Research Article
medicine.medical_specialty
Anti-HIV Agents
Immunology
Antiretroviral Therapy
Viral diseases
Microbiology
03 medical and health sciences
Life Expectancy
Antiviral Therapy
Acquired immunodeficiency syndrome (AIDS)
Retroviruses
medicine
Humans
Microbial Pathogens
Preventive healthcare
business.industry
Lentivirus
lcsh:R
Organisms
Infant
Biology and Life Sciences
HIV
medicine.disease
030112 virology
Infectious Disease Transmission
Vertical
Diagnostic medicine
Early Diagnosis
Age Groups
People and Places
Africa
Life expectancy
Population Groupings
Preventive Medicine
business
Zdroj: PLoS Medicine, Vol 14, Iss 11, p e1002446 (2017)
PLoS Medicine
ISSN: 1549-1676
1549-1277
Popis: Background The specificity of nucleic acid amplification tests (NAATs) used for early infant diagnosis (EID) of HIV infection is
Lorna Dunning examine the cost-effectiveness of confirmatory testing in early infant HIV diagnosis programmes in South Africa.
Author summary Why was this study done? Paediatric HIV remains a substantial burden in many low-resource countries, with 170,000 infants infected with HIV in 2015. The World Health Organization (WHO) recommends virological testing of HIV-exposed infants by 6 weeks of life, with immediate referral of those who test positive for initiation of HIV care to reduce infant mortality associated with HIV. Despite reported specificities greater than 99%, virological assays still have the possibility for false-positive diagnoses. The use of confirmatory testing is therefore strongly recommended in early infant diagnosis (EID) programmes. A recent policy survey by WHO demonstrated that implementation of confirmatory testing in EID programmes is limited, with 38% (8/21) of high-burden countries not including confirmatory testing for infants in their guidelines. Cost is often cited as a key barrier; many low-resource countries struggle to implement EID programmes due to the high costs of virological tests. Our study was designed to estimate the clinical and economic value of confirmatory testing in EID programmes. What did the researchers do and find? We used a computer simulation model of paediatric HIV infection, diagnosis, and treatment to examine the clinical and economic outcomes of EID programmes without and with confirmatory testing in South Africa. We found there was no clinical difference in the life expectancy or 1-year survival of HIV-infected infants between the 2 strategies, but without confirmatory testing, in settings with a mother-to-child transmission (MTCT) rate similar to that of South Africa, over 10% of infants initiating antiretroviral therapy (ART) would do so inappropriately as a result of a false-positive diagnosis. Confirmatory testing averted costly HIV care and ART in truly HIV-uninfected infants, leading the confirmatory testing strategy to be cost-saving compared to without confirmatory testing in all reasonable scenarios. ART should be initiated after the first positive test result; when ART was not initiated until the return of the confirmatory result, mortality during the delay to ART initiation substantially reduced survival for HIV-infected infants. What do these findings mean? Use of confirmatory testing in EID programmes, with ART initiation after the first positive result, substantially reduces the proportion of infants incorrectly diagnosed as HIV-infected and initiated on ART. Confirmatory testing is cost-saving under a wide range of scenarios. Confirmatory testing should be implemented in settings using virological assays for EID.
Databáze: OpenAIRE
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