The Cost-Effectiveness and Clinical Impact of Standard, Voluntary HIV Testing In South Africa

The Cost-Effectiveness and Clinical Impact of Standard, Voluntary HIV Testing In South AfricaAuthor’s name

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Table of Contents

TOC o “1-3” h z u Abstract Background PAGEREF _Toc315162396 h 3Study objectives PAGEREF _Toc315162397 h 3Methods PAGEREF _Toc315162398 h 3Ethics PAGEREF _Toc315162399 h 4Methods of Analysis Employed PAGEREF _Toc315162400 h 4Analytical approach PAGEREF _Toc315162401 h 4Efficacy data: PAGEREF _Toc315162402 h 4Cost data: PAGEREF _Toc315162403 h 4Analysis of ambiguity PAGEREF _Toc315162404 h 5Results PAGEREF _Toc315162405 h 5Conclusion PAGEREF _Toc315162406 h 5

The Cost-Effectiveness and Clinical Impact of Standard, Voluntary HIV Testing In South Africa

Abstract BackgroundThis study investigated the cost-effectiveness of voluntary HIV testing strategies. These strategies included, testing once in a lifetime, testing after each five years, and yearly screening. This was in addition to the common practice, for identification of HIV infected persons. The author concluded that yearly voluntary HIV testing, in South Africa, was extremely cost-effective, notwithstanding the inadequate uptake as well as access in regard to care and treatment. The cost-effectiveness structure was valid and major areas of ambiguity were considered.

Study objectivesThis study scrutinized three voluntary HIV testing strategies in regard to their cost-effectiveness. These strategies included, testing once in a lifetime, testing after each five years, and yearly screening. The study also focused on the common practice for identification of HIV infected persons.

MethodsThe Setting of the study was located in South Africa, with a focus on primary care. The study was motivated by the rising concern in regard to the high HIV prevalence in South Africa. The national HIV prevalence in South Africa in the populace of individuals two years and above is projected at 10.8%. Women depict a higher prevalence at 13.3%, while the prevalence in men is projected at 8.2%. The study focused on children from the age of 2 to 14 years, and adults from the age of 15 to 49 years. Individuals above the age of 50 years were also considered.

EthicsThe respondents were granted informed authority prior to their participation in the study. The researchers guaranteed this by notifying the relevant respondents about the rationale of this study. This included, the time limit, contents of the study, as well as the prospective risks. It also included the benefits significant to the study. The respondents were informed regarding the confidentiality of their identities. The researchers guaranteed this by refraining from linking the respondents to their responses to the survey.

Methods of Analysis EmployedAnalytical approachThe basis of the analysis was on a HIV detection model of population-level model, referred to as the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model.

Efficacy DataClinical data was estimated through the use of data from chosen studies principally executed in South Africa, which offered the data on the patients’ characteristics as well as epidemiology. The accuracy as well as the efficacy of the screening was from related published studies. HIV prevalence was a fundamental input for this model.

Cost DataEconomic analysis incorporated the costs of HIV screening, HIV care, regular care, out-patient, and in-patient hospital care, cluster of differentiation four (CD4) count, as well as HIV ribonucleic acid (RNA) test. The magnitude of resources and unit costs utilized were from the Clinton Foundation HIV/AIDS Initiative 2009, the CTAC study, inventory of negotiated costs, and supplementary published sources. These were discounted at a yearly rate of 3%. The costs were in US dollars.

Analysis of AmbiguityA variety of substitute settings were considered, with diverse assumptions for chosen model inputs. Substitute values were obtained from published sources or the authors’ postulations.

ResultsConsidering the entire population, the estimated costs per individual were $2,330 with standard practice, $2,570 with testing once, $2,740 with testing after every five year period, and $3,330 with yearly testing. Quality-adjusted life expectancy rated 213.7 months with standard practice, 215.7 months with testing once, 216.8 months in the five-yearly testing, and 221.0 months in the yearly testing. The incremental investigation depicted that testing once was imperceptibly dominated, since it was less helpful and not as much in cost-effectiveness, by five-yearly testing, while the incremental expenditure per Quality-adjusted life-years (QALYs) gained rated $1,570 in the five-yearly testing over standard practice and $1,720 with yearly testing over five-yearly testing. The two strategies proved to be economically attractive in comparison to the South African per capita GDP threshold.

The cost-effectiveness of testing was sustained in a number of scenarios, in spite of presumptuous low baseline incidence and prevalence of HIV. Antiretroviral therapy effectiveness was the parameter the depicted the strongest influence on the cost-effectiveness ratios. Yearly screening was generally, the most cost-effective stratagem.

ConclusionThe authors in the study concluded that yearly voluntary HIV testing in South Africa was extremely cost-effective, in spite of limited access and uptake to HIV care and treatment.

The authors acknowledged that their outcomes were expected to be generalized outside South Africa, in nations with similar high HIV prevalence.