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@article{Smith:2015:10.1016/S2352-3018(15)00016-8,
author = {Smith, JA and Sharma, M and Levin, C and Baeten, JM and van, Rooyen H and Celum, C and Hallett, TB and Barnabas, RV},
doi = {10.1016/S2352-3018(15)00016-8},
journal = {Lancet HIV},
pages = {e159--e168},
title = {Cost-effectiveness of community-based strategies to strengthen the continuum of HIV care in rural South Africa: a health economic modelling analysis},
url = {http://dx.doi.org/10.1016/S2352-3018(15)00016-8},
volume = {2},
year = {2015}
}

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TY  - JOUR
AB  - BackgroundHome HIV counselling and testing (HTC) achieves high coverage of testing and linkage to care compared with existing facility-based approaches, particularly among asymptomatic individuals. In a modelling analysis we aimed to assess the effect on population-level health and cost-effectiveness of a community-based package of home HTC in KwaZulu-Natal, South Africa.MethodsWe parameterised an individual-based model with data from home HTC and linkage field studies that achieved high coverage (91%) and linkage to antiretroviral therapy (80%) in rural KwaZulu-Natal, South Africa. Costs were derived from a linked microcosting study. The model simulated 10000 individuals over 10 years and incremental cost-effectiveness ratios were calculated for the intervention relative to the existing status quo of facility-based testing, with costs discounted at 3% annually.FindingsThe model predicted implementation of home HTC in addition to current practice to decrease HIV-associated morbidity by 10–22% and HIV infections by 9–48% with increasing CD4 cell count thresholds for antiretroviral therapy initiation. Incremental programme costs were US$2·7 million to $4·4 million higher in the intervention scenarios than at baseline, and costs increased with higher CD4 cell count thresholds for antiretroviral therapy initiation; antiretroviral therapy accounted for 48–87% of total costs. Incremental cost-effectiveness ratios per disability-adjusted life-year averted were $1340 at an antiretroviral therapy threshold of CD4 count lower than 200 cells per μL, $1090 at lower than 350 cells per μL, $1150 at lower than 500 cells per μL, and $1360 at universal access to antiretroviral therapy.InterpretationCommunity-based HTC with enhanced linkage to care can result in increased HIV testing coverage and treatment uptake, decreasing the population burden of HIV-associated morbidity and mortality. The incremental cost-effectiveness ratios are less tha
AU  - Smith,JA
AU  - Sharma,M
AU  - Levin,C
AU  - Baeten,JM
AU  - van,Rooyen H
AU  - Celum,C
AU  - Hallett,TB
AU  - Barnabas,RV
DO  - 10.1016/S2352-3018(15)00016-8
EP  - 168
PY  - 2015///
SN  - 2352-3018
SP  - 159
TI  - Cost-effectiveness of community-based strategies to strengthen the continuum of HIV care in rural South Africa: a health economic modelling analysis
T2  - Lancet HIV
UR  - http://dx.doi.org/10.1016/S2352-3018(15)00016-8
UR  - http://hdl.handle.net/10044/1/34271
VL  - 2
ER  -

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