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HIV testing and counselling couples together for affordable HIV prevention in Africa
BACKGROUND: The impact and cost-effectiveness of couples’ voluntary HIV counselling and testing (CVCT) has not been quantified in real-world settings. We quantify cost-per-HIV-infection averted by CVCT in Zambia from the donor’s perspective. METHODS: From 2010 to 2016, CVCT was established in 73 Zam...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380312/ https://www.ncbi.nlm.nih.gov/pubmed/30358840 http://dx.doi.org/10.1093/ije/dyy203 |
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author | Wall, Kristin M Inambao, Mubiana Kilembe, William Karita, Etienne Vwalika, Bellington Mulenga, Joseph Parker, Rachel Sharkey, Tyronza Sonti, Divya Tichacek, Amanda Hunter, Eric Yohnka, Robert Abdallah, Joseph F Thior, Ibou Pulerwitz, Julie Allen, Susan |
author_facet | Wall, Kristin M Inambao, Mubiana Kilembe, William Karita, Etienne Vwalika, Bellington Mulenga, Joseph Parker, Rachel Sharkey, Tyronza Sonti, Divya Tichacek, Amanda Hunter, Eric Yohnka, Robert Abdallah, Joseph F Thior, Ibou Pulerwitz, Julie Allen, Susan |
author_sort | Wall, Kristin M |
collection | PubMed |
description | BACKGROUND: The impact and cost-effectiveness of couples’ voluntary HIV counselling and testing (CVCT) has not been quantified in real-world settings. We quantify cost-per-HIV-infection averted by CVCT in Zambia from the donor’s perspective. METHODS: From 2010 to 2016, CVCT was established in 73 Zambian government clinics. The cost-per-HIV-infection averted (CHIA) of CVCT was calculated using observed expenditures and effectiveness over longitudinal follow-up. These observed measures parameterized hypothetical 5-year nationwide implementations of: ‘CVCT’; ‘treatment-as-prevention (TasP) for discordant couples’ identified by CVCT; and ‘population TasP’ for all HIV+ cohabiting persons identified by individual testing. RESULTS: In all, 207 428 couples were tested (US $52/couple). Among discordant couples in which HIV+ partners self-reported antiretroviral therapy (ART), HIV incidence was 8.5/100 person-years before and 1.8/100 person-years after CVCT (79% reduction). Corresponding reductions for non-ART-using discordant and concordant negative couples were 63% and 47%, respectively. CVCT averted an estimated 58% of new infections at US $659 CHIA. In nationwide implementation models, CVCT would prevent 17 times the number of infections vs ‘TasP for discordant couples’ at 86% of the cost, and nine times the infections vs ‘population TasP’ at 28% of the cost. CONCLUSIONS: CVCT is a cost-effective, feasible prevention strategy in Zambia. We demonstrate the novel, added effectiveness of providing CVCT to ART users, for whom ART use alone only partially mitigated transmission risk. Our results indicate a major policy shift (supporting development of CVCT indicators, budgets and targets) and have clinical implications (suggesting promotion of CVCT in ART clinics as a high-impact prevention strategy). |
format | Online Article Text |
id | pubmed-6380312 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-63803122019-02-22 HIV testing and counselling couples together for affordable HIV prevention in Africa Wall, Kristin M Inambao, Mubiana Kilembe, William Karita, Etienne Vwalika, Bellington Mulenga, Joseph Parker, Rachel Sharkey, Tyronza Sonti, Divya Tichacek, Amanda Hunter, Eric Yohnka, Robert Abdallah, Joseph F Thior, Ibou Pulerwitz, Julie Allen, Susan Int J Epidemiol Sexual Health BACKGROUND: The impact and cost-effectiveness of couples’ voluntary HIV counselling and testing (CVCT) has not been quantified in real-world settings. We quantify cost-per-HIV-infection averted by CVCT in Zambia from the donor’s perspective. METHODS: From 2010 to 2016, CVCT was established in 73 Zambian government clinics. The cost-per-HIV-infection averted (CHIA) of CVCT was calculated using observed expenditures and effectiveness over longitudinal follow-up. These observed measures parameterized hypothetical 5-year nationwide implementations of: ‘CVCT’; ‘treatment-as-prevention (TasP) for discordant couples’ identified by CVCT; and ‘population TasP’ for all HIV+ cohabiting persons identified by individual testing. RESULTS: In all, 207 428 couples were tested (US $52/couple). Among discordant couples in which HIV+ partners self-reported antiretroviral therapy (ART), HIV incidence was 8.5/100 person-years before and 1.8/100 person-years after CVCT (79% reduction). Corresponding reductions for non-ART-using discordant and concordant negative couples were 63% and 47%, respectively. CVCT averted an estimated 58% of new infections at US $659 CHIA. In nationwide implementation models, CVCT would prevent 17 times the number of infections vs ‘TasP for discordant couples’ at 86% of the cost, and nine times the infections vs ‘population TasP’ at 28% of the cost. CONCLUSIONS: CVCT is a cost-effective, feasible prevention strategy in Zambia. We demonstrate the novel, added effectiveness of providing CVCT to ART users, for whom ART use alone only partially mitigated transmission risk. Our results indicate a major policy shift (supporting development of CVCT indicators, budgets and targets) and have clinical implications (suggesting promotion of CVCT in ART clinics as a high-impact prevention strategy). Oxford University Press 2019-02 2018-10-24 /pmc/articles/PMC6380312/ /pubmed/30358840 http://dx.doi.org/10.1093/ije/dyy203 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of the International Epidemiological Association. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Sexual Health Wall, Kristin M Inambao, Mubiana Kilembe, William Karita, Etienne Vwalika, Bellington Mulenga, Joseph Parker, Rachel Sharkey, Tyronza Sonti, Divya Tichacek, Amanda Hunter, Eric Yohnka, Robert Abdallah, Joseph F Thior, Ibou Pulerwitz, Julie Allen, Susan HIV testing and counselling couples together for affordable HIV prevention in Africa |
title | HIV testing and counselling couples together for affordable HIV prevention in Africa |
title_full | HIV testing and counselling couples together for affordable HIV prevention in Africa |
title_fullStr | HIV testing and counselling couples together for affordable HIV prevention in Africa |
title_full_unstemmed | HIV testing and counselling couples together for affordable HIV prevention in Africa |
title_short | HIV testing and counselling couples together for affordable HIV prevention in Africa |
title_sort | hiv testing and counselling couples together for affordable hiv prevention in africa |
topic | Sexual Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380312/ https://www.ncbi.nlm.nih.gov/pubmed/30358840 http://dx.doi.org/10.1093/ije/dyy203 |
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