Clinical impact and cost-effectiveness of early infant HIV diagnosis in South Africa: Test timing and frequency

Background: Early infant HIV diagnosis (EID) and antiretroviral therapy dramatically reduce mortality. EID is recommended at six weeks of age, but many infant infections are missed. Design/Methods: We simulated four EID strategies for HIV-exposed infants in South Africa: no EID (diagnosis only after illness), testing once (birth alone; 6 weeks alone) and twice (birth and 6 weeks). We calculated incremental cost-effectiveness ratios (ICERs) using discounted costs and life expectancies for all HIV-exposed (infected and uninfected) infants. Results: In the base case (guideline-concordant care), no EID produced a life expectancy of 21.1y (HIVinfected) and 61.1y (HIV-exposed); lifetime cost averaged $1,430/HIV-exposed infant. The birth and 6 weeks strategy maximized life expectancy (HIV-infected: 26.5y; HIV-exposed: 61.4y), costing $1,840/infant tested. The ICER of 6 weeks alone vs. no EID was $1,250/year of life saved (YLS, 19% of South Africa's per-capita GDP); birth and 6 weeks vs. 6 weeks alone was $2,900/YLS (45% of GDP). Increasing result-return and linkage to ART with 6 weeks alone improved survival more than adding a second test. Conclusions: EID at birth and 6 weeks improves outcomes and is cost-effective, compared to 6 weeks alone. If scale-up costs are comparable, programs should add birth testing after strengthening 6-week testing programs. by Jles L evin on A uust 1, 2016 http://jidrdjournals.org/ D ow nladed from