Universal test, treat, and keep: improving ART retention is key in cost-effective HIV control in Uganda

BMC Infectious Diseases

Research Article

Trevelyan J. McKinley¹  Ian Vernon²  Michael Goldstein²  Richard Hayes³  Ioannis Andrianakis³  Richard G. White³  Nicky McCreesh³  Rebecca N. Nsubuga⁴  Mark Strong⁵  Jeremy E. Oakley⁶ 

[1] College of Engineering, Mathematics and Physical Sciences, University of Exeter, Campusm Penryn, TR10 9FE, Penryn, UK;Department of Mathematical Sciences, Durham University, Lower Mountjoy, Stockton Road, DH1 3LE, Durham, UK;London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK;MRC/UVRI Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda;School of Health and Related Research, The University of Sheffield, 30 Regent Street, S1 4DA, Sheffield, UK;School of Mathematics and Statistics, University of Sheffield, The Hicks Building, Hounsfield Road, S3 7RH, Sheffield, UK;

关键词: HIV;    ART;    Uganda;    Mathematical modelling;    Universal test and treat;    Cost-effectiveness;   

DOI  :  10.1186/s12879-017-2420-y

 received in 2016-12-13, accepted in 2017-04-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWith ambitious new UNAIDS targets to end AIDS by 2030, and new WHO treatment guidelines, there is increased interest in the best way to scale-up ART coverage. We investigate the cost-effectiveness of various ART scale-up options in Uganda.MethodsIndividual-based HIV/ART model of Uganda, calibrated using history matching. 22 ART scale-up strategies were simulated from 2016 to 2030, comprising different combinations of six single interventions (1. increased HIV testing rates, 2. no CD4 threshold for ART initiation, 3. improved ART retention, 4. increased ART restart rates, 5. improved linkage to care, 6. improved pre-ART care). The incremental net monetary benefit (NMB) of each intervention was calculated, for a wide range of different willingness/ability to pay (WTP) per DALY averted (health-service perspective, 3% discount rate).ResultsFor all WTP thresholds above $210, interventions including removing the CD4 threshold were likely to be most cost-effective. At a WTP of $715 (1 × per-capita-GDP) interventions to improve linkage to and retention/re-enrolment in HIV care were highly likely to be more cost-effective than interventions to increase rates of HIV testing. At higher WTP (> ~ $1690), the most cost-effective option was ‘Universal Test, Treat, and Keep’ (UTTK), which combines interventions 1–5 detailed above.ConclusionsOur results support new WHO guidelines to remove the CD4 threshold for ART initiation in Uganda. With additional resources, this could be supplemented with interventions aimed at improving linkage to and/or retention in HIV care. To achieve the greatest reductions in HIV incidence, a UTTK policy should be implemented.

【 授权许可】

CC BY   
© The Author(s). 2017