Imperial College London

Jeff Eaton

Faculty of MedicineSchool of Public Health

Senior Lecturer in HIV Epidemiology
 
 
 
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Contact

 

jeffrey.eaton

 
 
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Location

 

Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Olney:2016:10.1016/S2352-3018(16)30120-5,
author = {Olney, JJ and Braitstein, P and Eaton, JW and Sang, E and Nyambura, M and Kimaiyo, S and McRobie, E and Hogan, JW and Hallett, TB},
doi = {10.1016/S2352-3018(16)30120-5},
journal = {Lancet HIV},
pages = {e592--e600},
title = {Evaluating strategies to improve HIV care outcomes in Kenya: a modelling study},
url = {http://dx.doi.org/10.1016/S2352-3018(16)30120-5},
volume = {3},
year = {2016}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - BackgroundWith expanded access to antiretroviral therapy (ART) in sub-Saharan Africa, HIV mortality has decreased, yet life-years are still lost to AIDS. Strengthening of treatment programmes is a priority. We examined the state of an HIV care programme in Kenya and assessed interventions to improve the impact of ART programmes on population health.MethodsWe created an individual-based mathematical model to describe the HIV epidemic and the experiences of care among adults infected with HIV in Kenya. We calibrated the model to a longitudinal dataset from the Academic Model Providing Access To Healthcare (known as AMPATH) programme describing the routes into care, losses from care, and clinical outcomes. We simulated the cost and effect of interventions at different stages of HIV care, including improvements to diagnosis, linkage to care, retention and adherence of ART, immediate ART eligibility, and a universal test-and-treat strategy.FindingsWe estimate that, of people dying from AIDS between 2010 and 2030, most will have initiated treatment (61%), but many will never have been diagnosed (25%) or will have been diagnosed but never started ART (14%). Many interventions targeting a single stage of the health-care cascade were likely to be cost-effective, but any individual intervention averted only a small percentage of deaths because the effect is attenuated by other weaknesses in care. However, a combination of five interventions (including improved linkage, point-of-care CD4 testing, voluntary counselling and testing with point-of-care CD4, and outreach to improve retention in pre-ART care and on-ART) would have a much larger impact, averting 1·10 million disability-adjusted life-years (DALYs) and 25% of expected new infections and would probably be cost-effective (US$571 per DALY averted). This strategy would improve health more efficiently than a universal test-and-treat intervention if there were no accompanying improvements to care ($1760 per DALY avert
AU - Olney,JJ
AU - Braitstein,P
AU - Eaton,JW
AU - Sang,E
AU - Nyambura,M
AU - Kimaiyo,S
AU - McRobie,E
AU - Hogan,JW
AU - Hallett,TB
DO - 10.1016/S2352-3018(16)30120-5
EP - 600
PY - 2016///
SN - 2405-4704
SP - 592
TI - Evaluating strategies to improve HIV care outcomes in Kenya: a modelling study
T2 - Lancet HIV
UR - http://dx.doi.org/10.1016/S2352-3018(16)30120-5
UR - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000389072800013&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR - http://hdl.handle.net/10044/1/43878
VL - 3
ER -