HIV testing and counselling couples together for affordable HIV prevention in Africa
Year: 2018
Type: article
Study design: Observational Study
Abstract: 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).
DOI: 10.1093/ije/dyy203
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,514
Funders: United States Agency for International Development, International AIDS Vaccine Initiative, Department for International Development, UK Government, Department for International Development, National Institutes of Health, Centers for Disease Control and Prevention, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, Fogarty International Center, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: VCT with Primary and Concurrent Partners to Prevent HIV Transmission , Family Planning Promotion in HIV Infected Zambians, G4361643388, Improving allocation of limited HIV prevention and treatment resources in Zambia, Emory AIDS International Training and Research Program, Couples HIV Counseling & Testing in two African capitals, G7212345379, Virologic Correlates of Heterosexual Transmission, G7679542741, EXPANSION OF ZEHRP'S COUPLES VOLUNTARY COUNSELING AND TESTING SERVICES, Center for AIDS Research at Emory University, Emory National Primate Research Center
OpenAlex ID: W2898362767