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Voluntary Community Human Immunodeficiency Virus Testing, Linkage, and Retention in Care Interventions in Kenya: Modeling the Clinical Impact and Cost-effectiveness

Year: 2018
Type: article
Abstract: Background: In southwest Kenya, the prevalence of human immunodeficiency virus (HIV) infection is about 25%. Médecins Sans Frontières has implemented a voluntary community testing (VCT) program, with linkage to care and retention interventions, to achieve the Joint United Nations Program on HIV and AIDS (UNAIDS) 90-90-90 targets by 2017. We assessed the effectiveness and cost-effectiveness of these interventions. Methods: We developed a time-discrete, dynamic microsimulation model to project HIV incidence over time in the adult population in Kenya. We modeled 4 strategies: VCT, VCT-plus-linkage to care, a retention intervention, and all 3 interventions combined. Effectiveness outcomes included HIV incidence, years of life saved (YLS), cost (2014 €), and cost-effectiveness. We performed sensitivity analyses on key model parameters. Results: With current care, the projected HIV incidence for 2032 was 1.51/100 person-years (PY); the retention and combined interventions decreased incidence to 1.03/100 PY and 0.75/100 PY, respectively. For 100000 individuals, the retention intervention had an incremental cost-effectiveness ratio (ICER) of €130/YLS compared with current care; the combined intervention incremental cost-effectiveness ratio was €370/YLS compared with the retention intervention. VCT and VCT-plus-linkage interventions cost more and saved fewer life-years than the retention and combined interventions. Baseline HIV prevalence had the greatest impact on the results. Conclusions: Interventions targeting VCT, linkage to care, and retention would decrease HIV incidence rate over 15 years in rural Kenya if planned targets are achieved. These interventions together would be more effective and cost-effective than targeting a single stage of the HIV care cascade.
DOI: 10.1093/cid/ciy173
Authors: Liem B Luong Nguyen, Yazdan Yazdanpanah, David Maman, Sitima Wanjala, Alexandra Vandenbulcke, Jianthi Price, Robert A Parker, William Hennequin, Pierre Mendiharat, Kenneth A Freedberg
Institutions: Inserm, Sorbonne Paris Cité, Infection, Anti-microbiens, Modélisation, Evolution, Université Pierre-et-Marie-Curie, Epicentre, Médecins Sans Frontières, Harvard University, Massachusetts General Hospital
Language: English
Field: Medicine
Open Access status: hybrid
Estimated APC paid: $4,763
Funders: National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Child Health and Human Development, National Institute of Dental and Craniofacial Research, Office of AIDS Research, National Institute on Minority Health and Health Disparities
OpenAlex ID: W2799276746
FWCI: 0.567
Cites: 19
Cited by: 4
Related to: 10