Cost implications of HIV retesting for verification in Africa.
AIDS Serodiagnosis
/ economics
Africa
/ epidemiology
Anti-HIV Agents
/ economics
Antiretroviral Therapy, Highly Active
/ economics
Cost-Benefit Analysis
Developing Countries
Diagnostic Errors
Female
HIV Infections
/ diagnosis
Health Care Costs
/ statistics & numerical data
Humans
Income
/ statistics & numerical data
Male
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
23
08
2017
accepted:
12
06
2019
entrez:
2
7
2019
pubmed:
2
7
2019
medline:
19
2
2020
Statut:
epublish
Résumé
HIV misdiagnosis leads to severe individual and public health consequences. Retesting for verification of all HIV-positive cases prior to antiretroviral therapy initiation can reduce HIV misdiagnosis, yet this practice has not been not widely implemented. We evaluated and compared the cost of retesting for verification of HIV seropositivity (retesting) to the cost of antiretroviral treatment (ART) for misdiagnosed cases in the absence of retesting (no retesting), from the perspective of the health care system. We estimated the number of misdiagnosed cases based on a review of misdiagnosis rates, and the number of positives persons needing ART initiation by 2020. We presented the total and per person costs of retesting as compared to no retesting, over a ten-year horizon, across 50 countries in Africa grouped by income level. We conducted univariate sensitivity analysis on all model input parameters, and threshold analysis to evaluate the parameter values where the total costs of retesting and the costs no retesting are equivalent. Cost data were adjusted to 2017 United States Dollars. The estimated number of misdiagnoses, in the absence of retesting was 156,117, 52,720 and 29,884 for lower-income countries (LICs), lower-middle income countries (LMICs), and upper middle-income countries (UMICs), respectively, totaling 240,463 for Africa. Under the retesting scenario, costs per person initially diagnosed were: $40, $21, and $42, for LICs, LMICs, and UMICs, respectively. When retesting for verification is implemented, the savings in unnecessary ART were $125, $43, and $75 per person initially diagnosed, for LICs, LMICs, and UMICs, respectively. Over the ten-year horizon, the total costs under the retesting scenario, over all country income levels, was $475 million, and was $1.192 billion under the no retesting scenario, representing total estimated savings of $717 million in HIV treatment costs averted. Results show that to reduce HIV misdiagnosis, countries in Africa should implement the WHO's recommendation of retesting for verification prior to ART initiation, as part of a comprehensive quality assurance program for HIV testing services.
Identifiants
pubmed: 31260467
doi: 10.1371/journal.pone.0218936
pii: PONE-D-17-31059
pmc: PMC6602186
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0218936Subventions
Organisme : PEPFAR
Pays : United States
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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