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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
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).
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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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