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Published on: October 31, 2010
Cost-effectiveness of Routine Provider-Initiated Testing and Counseling for Children With Undiagnosed HIV in South
Tijana Stanic1, Nicole McCann1, Martina Penazzato2
1Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Provider-initiated HIV testing and counseling (PITC) for children in South Africa significantly improves diagnosis, treatment, and viral suppression. This routine testing strategy is highly cost-effective, proving beneficial across various pediatric care settings.
Area of Science:
- Pediatric infectious diseases
- Public health interventions
- Health economics
Background:
- South Africa faces a high burden of pediatric HIV.
- Effective strategies are needed to improve early diagnosis and treatment initiation.
- Provider-initiated testing and counseling (PITC) is a key approach to identify undiagnosed HIV in children.
Purpose of the Study:
- To evaluate the cost-effectiveness of pediatric provider-initiated HIV testing and counseling (PITC) compared to no PITC.
- To assess the impact of PITC on HIV diagnosis, antiretroviral therapy (ART) initiation, and viral suppression in children.
- To determine the cost-effectiveness threshold for implementing PITC in diverse South African clinical settings.
Main Methods:
- A simulation model (Cost-Effectiveness of Preventing AIDS Complications Pediatric model) was used to analyze a cohort of children aged 2-10 years.
- Four clinical settings with varying undiagnosed HIV prevalence were modeled: outpatient, malnutrition, inpatient, and tuberculosis clinics.
- Outcomes included life expectancy, lifetime costs, incremental cost-effectiveness ratios (ICERs), and proportions diagnosed, on ART, and virally suppressed, using a $3200/year of life saved (YLS) threshold.
Main Results:
- PITC significantly increased the proportion of children diagnosed with HIV (45.2% to 83.2%), on ART (40.8% to 80.4%), and virally suppressed (32.6% to 63.7%) within one year.
- PITC improved life expectancy by 0.1-0.7 years across all settings.
- The ICER for PITC ranged from $710 to $1240/YLS, remaining cost-effective even with low undiagnosed HIV prevalence (<0.2%).
Conclusions:
- Provider-initiated HIV testing and counseling is a cost-effective strategy for improving pediatric HIV outcomes in South Africa.
- PITC is recommended for implementation in outpatient, inpatient, tuberculosis, and malnutrition clinical settings.
- The cost-effectiveness of PITC is sustained as long as the prevalence of undiagnosed pediatric HIV exceeds 0.2%.
Background:
We compared the cost-effectiveness of pediatric provider-initiated HIV testing and counseling (PITC) vs no PITC in a range of clinical care settings in South Africa.
Methods:
We used the Cost-Effectiveness of Preventing AIDS Complications Pediatric model to simulate a cohort of children, aged 2-10 years, presenting for care in 4 settings (outpatient, malnutrition, inpatient, tuberculosis clinic) with varying prevalence of undiagnosed HIV (1.0%, 15.0%, 17.5%, 50.0%, respectively). We compared "PITC" (routine testing offered to all patients; 97% acceptance and 71% linkage to care after HIV diagnosis) with no PITC. Model outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs) from the health care system perspective and the proportion of children with HIV (CWH) diagnosed, on antiretroviral therapy (ART), and virally suppressed. We assumed a threshold of $3200/year of life saved (YLS) to determine cost-effectiveness. Sensitivity analyses varied the age distribution of children seeking care and costs for PITC, HIV care, and ART.
Results:
PITC improved the proportion of CWH diagnosed (45.2% to 83.2%), on ART (40.8% to 80.4%), and virally suppressed (32.6% to 63.7%) at 1 year in all settings. PITC increased life expectancy by 0.1-0.7 years for children seeking care (including those with and without HIV). In all settings, the ICER of PITC vs no PITC was very similar, ranging from $710 to $1240/YLS. PITC remained cost-effective unless undiagnosed HIV prevalence was <0.2%.
Conclusions:
Routine testing improves HIV clinical outcomes and is cost-effective in South Africa if the prevalence of undiagnosed HIV among children exceeds 0.2%. These findings support current recommendations for PITC in outpatient, inpatient, tuberculosis, and malnutrition clinical settings.
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