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The Impact of Monitoring HIV Patients Prior to Treatment in Resource-Poor Settings: Insights from Mathematical Modelling

BACKGROUND: The roll-out of antiretroviral treatment (ART) in developing countries concentrates on finding patients currently in need, but over time many HIV-infected individuals will be identified who will require treatment in the future. We investigated the potential influence of alternative patie...

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Autores principales: Hallett, Timothy B, Gregson, Simon, Dube, Sabada, Garnett, Geoff P
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265759/
https://www.ncbi.nlm.nih.gov/pubmed/18336064
http://dx.doi.org/10.1371/journal.pmed.0050053
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author Hallett, Timothy B
Gregson, Simon
Dube, Sabada
Garnett, Geoff P
author_facet Hallett, Timothy B
Gregson, Simon
Dube, Sabada
Garnett, Geoff P
author_sort Hallett, Timothy B
collection PubMed
description BACKGROUND: The roll-out of antiretroviral treatment (ART) in developing countries concentrates on finding patients currently in need, but over time many HIV-infected individuals will be identified who will require treatment in the future. We investigated the potential influence of alternative patient management and ART initiation strategies on the impact of ART programmes in sub-Saharan Africa. METHODS AND FINDINGS: We developed a stochastic mathematical model representing disease progression, diagnosis, clinical monitoring, and survival in a cohort of 1,000 hypothetical HIV-infected individuals in Africa. If individuals primarily enter ART programmes when symptomatic, the model predicts that only 25% will start treatment and, on average, 6 life-years will be saved per person treated. If individuals are recruited to programmes while still healthy and are frequently monitored, and CD4(+) cell counts are used to help decide when to initiate ART, three times as many are expected to be treated, and average life-years saved among those treated increases to 15. The impact of programmes can be improved further by performing a second CD4(+) cell count when the initial value is close to the threshold for starting treatment, maintaining high patient follow-up rates, and prioritising monitoring the oldest (≥ 35 y) and most immune-suppressed patients (CD4(+) cell count ≤ 350). Initiating ART at higher CD4(+) cell counts than WHO recommends leads to more life-years saved, but disproportionately more years spent on ART. CONCLUSIONS: The overall impact of ART programmes will be limited if rates of diagnosis are low and individuals enter care too late. Frequently monitoring individuals at all stages of HIV infection and using CD4 cell count information to determine when to start treatment can maximise the impact of ART.
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spelling pubmed-22657592008-03-11 The Impact of Monitoring HIV Patients Prior to Treatment in Resource-Poor Settings: Insights from Mathematical Modelling Hallett, Timothy B Gregson, Simon Dube, Sabada Garnett, Geoff P PLoS Med Research Article BACKGROUND: The roll-out of antiretroviral treatment (ART) in developing countries concentrates on finding patients currently in need, but over time many HIV-infected individuals will be identified who will require treatment in the future. We investigated the potential influence of alternative patient management and ART initiation strategies on the impact of ART programmes in sub-Saharan Africa. METHODS AND FINDINGS: We developed a stochastic mathematical model representing disease progression, diagnosis, clinical monitoring, and survival in a cohort of 1,000 hypothetical HIV-infected individuals in Africa. If individuals primarily enter ART programmes when symptomatic, the model predicts that only 25% will start treatment and, on average, 6 life-years will be saved per person treated. If individuals are recruited to programmes while still healthy and are frequently monitored, and CD4(+) cell counts are used to help decide when to initiate ART, three times as many are expected to be treated, and average life-years saved among those treated increases to 15. The impact of programmes can be improved further by performing a second CD4(+) cell count when the initial value is close to the threshold for starting treatment, maintaining high patient follow-up rates, and prioritising monitoring the oldest (≥ 35 y) and most immune-suppressed patients (CD4(+) cell count ≤ 350). Initiating ART at higher CD4(+) cell counts than WHO recommends leads to more life-years saved, but disproportionately more years spent on ART. CONCLUSIONS: The overall impact of ART programmes will be limited if rates of diagnosis are low and individuals enter care too late. Frequently monitoring individuals at all stages of HIV infection and using CD4 cell count information to determine when to start treatment can maximise the impact of ART. Public Library of Science 2008-03 2008-03-11 /pmc/articles/PMC2265759/ /pubmed/18336064 http://dx.doi.org/10.1371/journal.pmed.0050053 Text en : © 2008 Hallett et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Hallett, Timothy B
Gregson, Simon
Dube, Sabada
Garnett, Geoff P
The Impact of Monitoring HIV Patients Prior to Treatment in Resource-Poor Settings: Insights from Mathematical Modelling
title The Impact of Monitoring HIV Patients Prior to Treatment in Resource-Poor Settings: Insights from Mathematical Modelling
title_full The Impact of Monitoring HIV Patients Prior to Treatment in Resource-Poor Settings: Insights from Mathematical Modelling
title_fullStr The Impact of Monitoring HIV Patients Prior to Treatment in Resource-Poor Settings: Insights from Mathematical Modelling
title_full_unstemmed The Impact of Monitoring HIV Patients Prior to Treatment in Resource-Poor Settings: Insights from Mathematical Modelling
title_short The Impact of Monitoring HIV Patients Prior to Treatment in Resource-Poor Settings: Insights from Mathematical Modelling
title_sort impact of monitoring hiv patients prior to treatment in resource-poor settings: insights from mathematical modelling
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265759/
https://www.ncbi.nlm.nih.gov/pubmed/18336064
http://dx.doi.org/10.1371/journal.pmed.0050053
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