Point-of-care CD4 testing to inform selection of antiretroviral medications in south african antenatal clinics: a cost-effectiveness analysis

PloS One
Andrea L CiaranelloRochelle P Walensky

Abstract

Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3...Continue Reading

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Citations

Jun 30, 2016·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Landon MyerElaine J Abrams
Oct 3, 2017·AIDS Research and Human Retroviruses·George AlemnjiRachel Albalak
Feb 16, 2019·BMC Health Services Research·Fiona ScorgieMatthew F Chersich
Sep 3, 2016·Diagnostics·Tivani P Mashamba-ThompsonPaul K Drain
Jan 7, 2021·PharmacoEconomics Open·Deon LingervelderMaarten J IJzerman

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Methods Mentioned

BETA
flow cytometry

Software Mentioned

TreeAgePro

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