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Gergen M, Hewitt A, Sanger CB, Striker R. Monitoring immune recovery on HIV therapy: critical, helpful, or waste of money in the current era? AIDS 2024; 38:937-943. [PMID: 38310348 PMCID: PMC11064897 DOI: 10.1097/qad.0000000000003850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Affiliation(s)
| | | | - Cristina B. Sanger
- Department of Surgery
- Department of Surgery, W. S. Middleton Memorial Veterans’ Hospital, Madison, WI, USA
| | - Rob Striker
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health
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Samarasekera U. Yee-Sin Leo: a leader in Singapore's fight against infectious diseases. Lancet 2021; 397:1873. [PMID: 34022976 PMCID: PMC8137301 DOI: 10.1016/s0140-6736(21)01101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Thomas R, Probert WJM, Sauter R, Mwenge L, Singh S, Kanema S, Vanqa N, Harper A, Burger R, Cori A, Pickles M, Bell-Mandla N, Yang B, Bwalya J, Phiri M, Shanaube K, Floyd S, Donnell D, Bock P, Ayles H, Fidler S, Hayes RJ, Fraser C, Hauck K. Cost and cost-effectiveness of a universal HIV testing and treatment intervention in Zambia and South Africa: evidence and projections from the HPTN 071 (PopART) trial. Lancet Glob Health 2021; 9:e668-e680. [PMID: 33721566 PMCID: PMC8050197 DOI: 10.1016/s2214-109x(21)00034-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/15/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The HPTN 071 (PopART) trial showed that a combination HIV prevention package including universal HIV testing and treatment (UTT) reduced population-level incidence of HIV compared with standard care. However, evidence is scarce on the costs and cost-effectiveness of such an intervention. METHODS Using an individual-based model, we simulated the PopART intervention and standard care with antiretroviral therapy (ART) provided according to national guidelines for the 21 trial communities in Zambia and South Africa (for all individuals aged >14 years), with model parameters and primary cost data collected during the PopART trial and from published sources. Two intervention scenarios were modelled: annual rounds of PopART from 2014 to 2030 (PopART 2014-30; as the UNAIDS Fast-Track target year) and three rounds of PopART throughout the trial intervention period (PopART 2014-17). For each country, we calculated incremental cost-effectiveness ratios (ICERs) as the cost per disability-adjusted life-year (DALY) and cost per HIV infection averted. Cost-effectiveness acceptability curves were used to indicate the probability of PopART being cost-effective compared with standard care at different thresholds of cost per DALY averted. We also assessed budget impact by projecting undiscounted costs of the intervention compared with standard care up to 2030. FINDINGS During 2014-17, the mean cost per person per year of delivering home-based HIV counselling and testing, linkage to care, promotion of ART adherence, and voluntary medical male circumcision via community HIV care providers for the simulated population was US$6·53 (SD 0·29) in Zambia and US$7·93 (0·16) in South Africa. In the PopART 2014-30 scenario, median ICERs for PopART delivered annually until 2030 were $2111 (95% credible interval [CrI] 1827-2462) per HIV infection averted in Zambia and $3248 (2472-3963) per HIV infection averted in South Africa; and $593 (95% CrI 526-674) per DALY averted in Zambia and $645 (538-757) per DALY averted in South Africa. In the PopART 2014-17 scenario, PopART averted one infection at a cost of $1318 (1098-1591) in Zambia and $2236 (1601-2916) in South Africa, and averted one DALY at $258 (225-298) in Zambia and $326 (266-391) in South Africa, when outcomes were projected until 2030. The intervention had almost 100% probability of being cost-effective at thresholds greater than $700 per DALY averted in Zambia, and greater than $800 per DALY averted in South Africa, in the PopART 2014-30 scenario. Incremental programme costs for annual rounds until 2030 were $46·12 million (for a mean of 341 323 people) in Zambia and $30·24 million (for a mean of 165 852 people) in South Africa. INTERPRETATION Combination prevention with universal home-based testing can be delivered at low annual cost per person but accumulates to a considerable amount when scaled for a growing population. Combination prevention including UTT is cost-effective at thresholds greater than $800 per DALY averted and can be an efficient strategy to reduce HIV incidence in high-prevalence settings. FUNDING US National Institutes of Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ranjeeta Thomas
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - William J M Probert
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rafael Sauter
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Surya Singh
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Nosivuyile Vanqa
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Abigail Harper
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Cape Town, South Africa
| | - Anne Cori
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Nomtha Bell-Mandla
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Blia Yang
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Peter Bock
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Helen Ayles
- Zambart, University of Zambia, Lusaka, Zambia; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Richard J Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Katharina Hauck
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
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Goyal R, Hu C, Klein PW, Hotchkiss J, Morris E, Mandsager P, Cohen SM, Luca D, Gao J, Jones A, Addison W, O'Brien-Strain M, Cheever LW, Gilman B. Development of a Mathematical Model to Estimate the Cost-Effectiveness of HRSA's Ryan White HIV/AIDS Program. J Acquir Immune Defic Syndr 2021; 86:164-173. [PMID: 33109934 DOI: 10.1097/qai.0000000000002546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Health Resources and Services Administration's Ryan White HIV/AIDS Program provides services to more than half of all people diagnosed with HIV in the United States. We present and validate a mathematical model that can be used to estimate the long-term public health and cost impact of the federal program. METHODS We developed a stochastic, agent-based model that reflects the current HIV epidemic in the United States. The model simulates everyone's progression along the HIV care continuum, using 2 network-based mechanisms for HIV transmission: injection drug use and sexual contact. To test the validity of the model, we calculated HIV incidence, mortality, life expectancy, and lifetime care costs and compared the results with external benchmarks. RESULTS The estimated HIV incidence rate for men who have sex with men (502 per 100,000 person years), mortality rate of all people diagnosed with HIV (1663 per 100,000 person years), average life expectancy for individuals with low CD4 counts not on antiretroviral therapy (1.52-3.78 years), and lifetime costs ($362,385) all met our validity criterion of within 15% of external benchmarks. CONCLUSIONS The model represents a complex HIV care delivery system rather than a single intervention, which required developing solutions to several challenges, such as calculating need for and receipt of multiple services and estimating their impact on care retention and viral suppression. Our strategies to address these methodological challenges produced a valid model for assessing the cost-effectiveness of the Ryan White HIV/AIDS Program.
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Affiliation(s)
| | | | - Pamela W Klein
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | | | | | - Paul Mandsager
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | | | | | | | | | | | - Laura W Cheever
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
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Williams N, Mayer C, Huser V. A Descriptive Study of HIV Patients Highly Adherent to Antiretroviral. AMIA Annu Symp Proc 2021; 2020:1295-1304. [PMID: 33936506 PMCID: PMC8075478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
HIV medication adherence is a topic of major public health concern in the United States. Adherent patients may be less likely to experience treatment failure, AIDS presentations and extreme medical costs. We evaluate a cohort of highly adherent Medicare beneficiaries to establish if the out of pocket costs of HIV medications are an inherent barrier to adherence. We analyzed a 100% sample of Medicare Part-D prescription medications. The drug and out ofpocket costs for HIV and non-HIV medications of highly adherent cohort were extracted and analyzed. The average gross drug cost per beneficiary was $34,029for HIV medications and $11,439for non-HIV medications. Average out of pocket costs per beneficiary was $454for HIV medications and $129 for non-HIV medications. Out of pocket costs do not reasonably appear to be a barrier to adherence for Part-D beneficiaries.
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Affiliation(s)
- Nick Williams
- The Lister Hill National Center for Biomedical Communications, National Library of Medicine, NIH, Bethesda, MD
| | - Craig Mayer
- The Lister Hill National Center for Biomedical Communications, National Library of Medicine, NIH, Bethesda, MD
| | - Vojtech Huser
- The Lister Hill National Center for Biomedical Communications, National Library of Medicine, NIH, Bethesda, MD
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Saag MS, Gandhi RT, Hoy JF, Landovitz RJ, Thompson MA, Sax PE, Smith DM, Benson CA, Buchbinder SP, Del Rio C, Eron JJ, Fätkenheuer G, Günthard HF, Molina JM, Jacobsen DM, Volberding PA. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2020 Recommendations of the International Antiviral Society-USA Panel. JAMA 2020; 324:1651-1669. [PMID: 33052386 PMCID: PMC11017368 DOI: 10.1001/jama.2020.17025] [Citation(s) in RCA: 287] [Impact Index Per Article: 71.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices. Objective To evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV. Evidence Review New evidence was collected since the previous International Antiviral (formerly AIDS) Society-USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations. Findings From 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic. Conclusion and Relevance Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.
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Affiliation(s)
| | - Rajesh T Gandhi
- Harvard Medical School and Massachusetts General Hospital, Boston
| | - Jennifer F Hoy
- Monash University and Alfred Hospital, Melbourne, Australia
| | | | | | - Paul E Sax
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Susan P Buchbinder
- San Francisco Department of Public Health and University of California, San Francisco
| | | | - Joseph J Eron
- School of Medicine, University of North Carolina, Chapel Hill
| | | | - Huldrych F Günthard
- University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jean-Michel Molina
- University of Paris and Saint-Louis/Lariboisière Hospitals, APHP, Paris, France
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Dada DA, Aku E, David KB. COVID-19 pandemic and antiretrovirals (ARV) availability in Nigeria: recommendations to prevent shortages. Pan Afr Med J 2020; 35:149. [PMID: 33193964 PMCID: PMC7608769 DOI: 10.11604/pamj.supp.2020.35.149.25639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 12/02/2022] Open
Abstract
HIV/AIDS is an infectious disease that has claimed the lives of millions of people worldwide. Currently, there is no vaccine that has been developed in a bid to fight this deadly infection, however, antiretrovirals (ARVs), which are drugs used in the treatment of HIV infection are routinely prescribed to infected persons. They act via several mechanisms of action to reduce the severity of infection and rate of infectivity of the virus by decreasing the viral load while increasing CD4 counts. COVID-19 pandemic has resulted in unprecedented events affecting almost all areas of humans' life including availability of medicines and other consumables. This paper analyses the availability of ARVs during COVID-19 era and offered recommendations to be adopted in order to prevent shortages.
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Affiliation(s)
- David Adelekan Dada
- Faculty of Pharmaceutical Sciences, Kaduna State University, Kaduna, Nigeria
| | - Emmanuel Aku
- Department of Microbiology, Kaduna State University, Kaduna, Nigeria
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Minnery M, Mathabela N, Shubber Z, Mabuza K, Gorgens M, Cheikh N, Wilson DP, Kelly SL. Opportunities for improved HIV prevention and treatment through budget optimization in Eswatini. PLoS One 2020; 15:e0235664. [PMID: 32701968 PMCID: PMC7377429 DOI: 10.1371/journal.pone.0235664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 06/20/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Eswatini achieved a 44% decrease in new HIV infections from 2014 to 2019 through substantial scale-up of testing and treatment. However, it still has one of the highest rates of HIV incidence in the world, with 14 infections per 1,000 adults 15-49 years estimated for 2017. The Government of Eswatini has called for an 85% reduction in new infections by 2023 over 2017 levels. To make further progress towards this target and to achieve maximum health gains, this study aims to model optimized investments of available HIV resources. METHODS The Optima HIV model was applied to estimate the impact of efficiency strategies to accelerate prevention of HIV infections and HIV-related deaths. We estimated the number of infections and deaths that could be prevented by optimizing HIV investments. We optimize across HIV programs, then across service delivery modalities for voluntary medical male circumcision (VMMC), HIV testing, and antiretroviral refill, as well as switching to a lower cost antiretroviral regimen. FINDINGS Under an optimized budget, prioritising HIV testing for the general population followed by key preventative interventions may result in approximately 1,000 more new infections (2% more) being averted by 2023. More infections could be averted with further optimization between service delivery modalities across the HIV cascade. Scaling-up index and self-testing could lead to 100,000 more people getting tested for HIV (25% more tests) with the same budget. By prioritizing Fast-Track, community-based, and facility-based antiretroviral refill options, an estimated 30,000 more people could receive treatment, 17% more than baseline or US$5.5 million could be saved, 4% of the total budget. Finally, switching non-pregnant HIV-positive adults to a Dolutegravir-based antiretroviral therapy regimen and concentrating delivery of VMMC to existing fixed facilities over mobile clinics, US$4.5 million (7% of total budget) and US$6.6 million (10% of total budget) could be saved, respectively. SIGNIFICANCE With a relatively short five-year timeframe, even under a substantially increased and optimized budget, Eswatini is unlikely to reach their ambitious national prevention target by 2023. However, by optimizing investment of the same budget towards highly cost-effective VMMC, testing, and treatment modalities, further reductions in HIV incidence and cost savings could be realized.
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Affiliation(s)
| | - Nokwazi Mathabela
- Independent, formerly National Emergency Response Council on HIV/AIDS, Mbabane, Eswatini
| | - Zara Shubber
- World Bank Group, Washington, DC, United States of America
| | - Khanya Mabuza
- National Emergency Response Council on HIV/AIDS, Mbabane, Eswatini
| | | | - Nejma Cheikh
- World Bank Group, Washington, DC, United States of America
| | - David P. Wilson
- Burnet Institute, Melbourne, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
- University of Maryland, Baltimore, Maryland, United States of America
- Monash University, Melbourne, Australia
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Alvi Y, Faizi N, Khalique N, Ahmad A. Assessment of out-of-pocket and catastrophic expenses incurred by patients with Human Immunodeficiency Virus (HIV) in availing free antiretroviral therapy services in India. Public Health 2020; 183:16-22. [PMID: 32413804 DOI: 10.1016/j.puhe.2020.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES With the free availability of antiretroviral therapy in India, one expects that the out-of-pocket (OOP) expenditure would reduce and would not be a significant financial burden. However, the cost of seeking care is also dependent on accessibility of services, as well as other non-medical and indirect expenses. This study aims to analyze the OOP expenditure in availing antiretroviral therapy (ART) services and determine the prevalence and pattern of catastrophic and impoverishing health expenditure. The study also discusses the policy implications of these findings in the light of growing commitment toward universal health coverage. STUDY DESIGN This was a cross-sectional study. METHODS A total of 434 patients receiving antiretroviral treatment were interviewed. OOP expenses included a measure of direct medical expenditure, non-medical expenditure, and indirect expenditure incurred in availing ART services. A threshold level of 40% of 'capacity to pay' was taken as catastrophic expenditure. Based on previous research, different demographic, socio-economic, and clinical factors were selected as independent variables to determine their association with catastrophic expenditure. Logistic regression was conducted to study the association between independent and dependent variables keeping the level of significance at <0.05. RESULTS The mean OOP expenditure among patients with human immunodeficiency virus (HIV) taking ART was Rs. 238.8 ± 193.7. Majority of these expenses were incurred on non-medical expenditure (58.1%), while indirect expenditure accounted for 29.7%. The direct health expenditure was the lowest (12.2%) type of expenditure in the total OOP expenditure. OOP spending was catastrophic in 8.1% (35/434) of households in our study. Patients belonging to nuclear family (odds ratio [OR] = 2.99; 95% confidence interval [CI] = 1.19-7.58), who are unemployed (OR = 2.56; 95% CI = 1.18-5.54), of lower socio-economic classes (OR = 8.46; 95% CI = 1.93-37.02), those who traveled more than 50 km for getting drugs (OR = 2.80; 95% CI = 1.26-6.23), and those having CD4 cell count lower than 200 (OR = 3.11; 95% CI = 1.32-7.32) were found to be independently and significantly associated with catastrophic OOP health expenditure among patients with HIV. CONCLUSIONS A high direct and indirect expenditure was observed among patients with HIV seeking treatment in North India leading to catastrophic expenditure in a significant number of households. A service-level integration of HIV care at subdistrict levels within the Universal health coverage (UHC) framework could reduce catastrophic expenditure.
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Affiliation(s)
- Y Alvi
- Department of Community Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh Muslim University (AMU), Aligarh, India.
| | - N Faizi
- Department of Community Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh Muslim University (AMU), Aligarh, India.
| | - N Khalique
- Department of Community Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh Muslim University (AMU), Aligarh, India.
| | - A Ahmad
- Department of Community Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh Muslim University (AMU), Aligarh, India.
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Hing M, Hoffman RM, Seleman J, Chibwana F, Kahn D, Moucheraud C. 'Blood pressure can kill you tomorrow, but HIV gives you time': illness perceptions and treatment experiences among Malawian individuals living with HIV and hypertension. Health Policy Plan 2020; 34:ii36-ii44. [PMID: 31723966 DOI: 10.1093/heapol/czz112] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 01/03/2023] Open
Abstract
Non-communicable diseases like hypertension are increasingly common among individuals living with HIV in low-resource settings. The prevalence of hypertension among people with HIV in Malawi, e.g. has been estimated to be as high as 46%. However, few qualitative studies have explored the patient experience with comorbid chronic disease. Our study aimed to address this gap by using the health belief model (HBM) to examine how comparative perceptions of illness and treatment among participants with both HIV and hypertension may affect medication adherence behaviours. We conducted semi-structured interviews with 75 adults with HIV and hypertension at an urban clinic in Lilongwe, Malawi. Questions addressed participants' experiences with antiretroviral and antihypertensive medications, as well as their perspectives on HIV and hypertension as illnesses. Interviews were performed in Chichewa, transcribed, translated into English and analysed using ATLAS.ti. Deductive codes were drawn from the HBM and interview guide, with inductive codes added as they emerged from the data. Self-reported medication adherence was much poorer for hypertension than HIV, but participants saw hypertension as a disease at least as concerning as HIV-primarily due to the perceived severity of hypertension's consequences and participants' limited ability to anticipate them compared with HIV. Differences in medication adherence were attributed to the high costs of antihypertensive medications relative to the free availability of antiretroviral therapy, with other factors like lifestyle changes and self-efficacy also influencing adherence practices. These findings demonstrate how participants draw on past experiences with HIV to make sense of hypertension in the present, and suggest that although patients are motivated to control their hypertension, they face individual- and system-level obstacles in adhering to treatment. Thus, health policies and systems seeking to provide integrated care for HIV and hypertension should be attentive to the complex illness experiences of individuals living with these diseases.
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Affiliation(s)
- Matthew Hing
- Department of Medicine, University of California Los Angeles, David Geffen School of Medicine, Le Conte Ave, Los Angeles, CA, USA
| | - Risa M Hoffman
- Department of Medicine, University of California Los Angeles, David Geffen School of Medicine, Le Conte Ave, Los Angeles, CA, USA
- Partners in Hope, (Area 36/Plot 8), Lilongwe, Malawi
| | | | | | - Daniel Kahn
- Department of Medicine, University of California Los Angeles, David Geffen School of Medicine, Le Conte Ave, Los Angeles, CA, USA
| | - Corrina Moucheraud
- Department of Health Policy and Management, University of California Los Angeles, Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA, USA
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Olivieri-Mui BL, Koethe B, Briesacher B. Economic Barriers to Antiretroviral Therapy in Nursing Homes. J Am Geriatr Soc 2020; 68:777-782. [PMID: 31829445 PMCID: PMC7578773 DOI: 10.1111/jgs.16288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Our aim was to clarify if persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have adequate economic access to antiretroviral therapy (ART) when admitted to nursing homes (NHs). Medicare Part A pays NHs a bundled skilled nursing rate that includes prescription drugs for up to 100 days, after which individuals are responsible for the costs. DESIGN A cross-sectional study. SETTING NHs. PARTICIPANTS A total of 694 newly admitted long-stay (>100 d) NH residents with HIV. MEASUREMENTS We used Minimum Dataset v.3.0, pharmacy dispensing data, NH provider surveys, and Medicare claims from 2011 to 2013. We assessed receipt of any HIV antiretrovirals or recommended combinations (ART), as defined by national care guidelines, and the source of payment. We identified predictors of antiretroviral use with risk-adjusted generalized estimating equation logistic models. RESULTS All study persons living with HIV/AIDS in NHs had prescription drug coverage through Medicare's Part D program, and ART was 100% covered. However, only 63.9% received recommended ART, and 15.2% never received any antiretrovirals during their NH stay. The strongest predictor of not receiving antiretrovirals was the first 100 days of a long NH stay (odds ratio [OR] = .44; 95% confidence interval [CI] = .24-.80). The strongest predictor of receiving recommended ART was health acuity (OR = 1.51; 95% CI = 1.20-1.88). CONCLUSION People living with HIV in NHs do not always receive lifesaving ART, but the reasons are unclear and appear unrelated to economic barriers. J Am Geriatr Soc 68:777-782, 2020.
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Affiliation(s)
- Brianne L Olivieri-Mui
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Koethe
- Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, Massachusetts
| | - Becky Briesacher
- Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, Massachusetts
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Gostin LO, Rai AK. Expanding Access and Reducing Prices for Drugs to Prevent HIV: Should Government Enforce Its Patent Rights Against the Pharmaceutical Industry? JAMA 2020; 323:821-822. [PMID: 32125411 DOI: 10.1001/jama.2019.22357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Arti K Rai
- Duke University School of Law, Durham, North Carolina
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Rautenberg TA, George G, Bwana MB, Moosa MS, Pillay S, McCluskey SM, Aturinda I, Ard K, Muyindike W, Moodley P, Brijkumar J, Johnson BA, Gandhi RT, Sunpath H, Marconi VC, Siedner MJ. Comparative analyses of published cost effectiveness models highlight critical considerations which are useful to inform development of new models. J Med Econ 2020; 23:221-227. [PMID: 31835974 PMCID: PMC7105898 DOI: 10.1080/13696998.2019.1705314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Comparative analyses of published cost effectiveness models provide useful insights into critical issues to inform the development of new cost effectiveness models in the same disease area.Objective: The purpose of this study was to describe a comparative analysis of cost-effectiveness models and highlight the importance of such work in informing development of new models. This research uses genotypic antiretroviral resistance testing after first line treatment failure for Human Immunodeficiency Virus (HIV) as an example.Method: A literature search was performed, and published cost effectiveness models were selected according to predetermined eligibility criteria. A comprehensive comparative analysis was undertaken for all aspects of the models.Results: Five published models were compared, and several critical issues were identified for consideration when developing a new model. These include the comparator, time horizon and scope of the model. In addition, the composite effect of drug resistance prevalence, antiretroviral therapy efficacy, test performance and the proportion of patients switching to second-line ART potentially have a measurable effect on model results. When considering CD4 count and viral load, dichotomizing patients according to higher cost and lower quality of life (AIDS) versus lower cost and higher quality of life (non-AIDS) status will potentially capture differences between resistance testing and other strategies, which could be confirmed by cross-validation/convergent validation. A quality adjusted life year is an essential outcome which should be explicitly explored in probabilistic sensitivity analysis, where possible.Conclusions: Using an example of GART for HIV, this study demonstrates comparative analysis of previously published cost effectiveness models yields critical information which can be used to inform the structure and specifications of new models.
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Affiliation(s)
- T. A. Rautenberg
- Division of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Centre for Applied Health Economics, Griffith University, Nathan, Australia
| | - G. George
- Division of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - M. B. Bwana
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - M. S. Moosa
- Division of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - S. Pillay
- Division of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - S. M. McCluskey
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - I. Aturinda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - K. Ard
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - W. Muyindike
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - P. Moodley
- Division of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - J. Brijkumar
- Division of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - B. A. Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - R. T. Gandhi
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - H. Sunpath
- Division of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - V. C. Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M. J. Siedner
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Roberts DA, Tan N, Limaye N, Irungu E, Barnabas RV. Cost of Differentiated HIV Antiretroviral Therapy Delivery Strategies in Sub-Saharan Africa: A Systematic Review. J Acquir Immune Defic Syndr 2019; 82 Suppl 3:S339-S347. [PMID: 31764272 PMCID: PMC6884078 DOI: 10.1097/qai.0000000000002195] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Efficient and scalable models for HIV treatment are needed to maximize health outcomes with available resources. By adapting services to client needs, differentiated antiretroviral therapy (DART) has the potential to use resources more efficiently. We conducted a systematic review assessing the cost of DART in sub-Saharan Africa compared with the standard of care. METHODS We searched PubMed, Embase, Global Health, EconLit, and the grey literature for studies published between 2005 and 2019 that assessed the cost of DART. Models were classified as facility-vs. community-based and individual- vs group-based. We extracted the annual per-patient service delivery cost and incremental cost of DART compared with standard of care in 2018 USD. RESULTS We identified 12 articles that reported costs for 16 DART models in 7 countries. The majority of models were facility-based (n = 12) and located in Uganda (n = 7). The annual cost per patient within DART models (excluding drugs) ranged from $27 to $889 (2018 USD). Of the 11 models reporting incremental costs, 7 found DART to be cost saving. The median incremental saving per patient per year among cost-saving models was $67. Personnel was the most common driver of reduced costs, but savings were sometimes offset by higher overheads or utilization. CONCLUSIONS DART models can save personnel costs by task shifting and reducing visit frequency. Additional economic evidence from community-based and group models is needed to better understand the scalability of DART. To decrease costs, programs will need to match DART models to client needs without incurring substantial overheads.
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Affiliation(s)
- D Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Nicholas Tan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nishaant Limaye
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Elizabeth Irungu
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Ruanne V. Barnabas
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Mathivha E, Olorunju S, Jackson D, Dinh TH, du Plessis N, Goga A. Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa. BMC Infect Dis 2019; 19:790. [PMID: 31526376 PMCID: PMC6745775 DOI: 10.1186/s12879-019-4342-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Loss to follow-up after a positive infant HIV diagnosis negates the potential benefits of robust policies recommending immediate triple antiretroviral therapy initiation in HIV positive infants. Whilst the diagnosis and follow-up of HIV positive infants in urban, specialized settings is easier to institutionalize, there is little information about access to care amongst HIV positive children diagnosed at primary health care clinic level. We sought to understand the characteristics of HIV positive children diagnosed with HIV infection at primary health care level, across all provinces of South Africa, their attendance at study-specific exit interviews and their reported uptake of HIV-related care. The latter could serve as a marker of knowledge, access or disclosure. METHODS Secondary analysis of data gathered about HIV positive children, participating in an HIV-exposed infant national observational cohort study between October 2012 and September 2014, was undertaken. HIV infected children were identified by total nucleic acid polymerase chain reaction using standardized procedures in a nationally accredited central laboratory. Descriptive analyses were conducted on the HIV positive infant population, who were treated as a case series in this analysis. Data from interviews conducted at baseline (six-weeks post-delivery) and on study exit (the first visit following infant HIV positive diagnosis) were analysed. RESULTS Of the 2878 HIV exposed infants identified at 6 weeks, 1803 (62.2%), 1709, 1673, 1660, 1680 and 1794 were see at 3, 6, 9, 12, 15 and 18 months respectively. In total, 101 tested HIV positive (67 at 6 weeks, and 34 postnatally). Most (76%) HIV positive infants were born to single mothers with a mean age of 26 years and an education level above grade 7 (76%). Although only 33.7% of pregnancies were planned, 83% of mothers reported receiving antiretroviral drugs to prevent MTCT. Of the 44 mothers with a documented recent CD4 cell count, the median was 346.8 cell/mm3. Four mothers (4.0%) self-reported having had TB. Only 59 (58.4%) HIV positive infants returned for an exit interview after their HIV diagnosis; there were no statistically significant differences in baseline characteristics between HIV positive infants who returned for an exit interview and those who did not. Amongst HIV positive infants who returned for an exit interview, only two HIV positive infants (3.4%) were reportedly receiving triple antiretroviral therapy (ART). If we assume that all HIV positive children who did not return for their exit interview received ART, then ART uptake amongst these HIV positive children < 18 months would be 43.6%. CONCLUSIONS Early ART uptake amongst children aged 15 months and below was low. This raises questions about timely, early paediatric ART uptake amongst HIV positive children diagnosed in primary health care settings. Qualitative work is needed to understand low and delayed paediatric ART uptake in young children, and more work is needed to measure progress with infant ART initiation at primary care level since 2014.
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Affiliation(s)
- Elelwani Mathivha
- Mamelodi Hospital, Pretoria, 0112 South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, 0001 South Africa
| | - Steve Olorunju
- Biostistics Unit, South African Medical Research Council, Pretoria, 0001 South Africa
| | - Debra Jackson
- Health Section, United Nations Children’s Fund (UNICEF), New York, NY 10017 USA
- School of Public Health, University of the Western Cape, Cape Town, 7535 South Africa
| | - Thu-Ha Dinh
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | | | - Ameena Goga
- Department of Paediatrics, University of Pretoria, Pretoria, 0001 South Africa
- Health Systems Research Unit, South African Medical Research Council, Pretoria, 0001 South Africa
- 8 HIV Prevention Research Unit, South African Medical Research Counci, Durban, 3630 South Africa
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Hu QH, Meyers K, Xu JJ, Chu ZX, Zhang J, Ding HB, Han XX, Jiang YJ, Geng WQ, Shang H. Efficacy and cost-effectiveness of early antiretroviral therapy and partners' pre-exposure prophylaxis among men who have sex with men in Shenyang, China: a prospective cohort and costing study. BMC Infect Dis 2019; 19:663. [PMID: 31345169 PMCID: PMC6659226 DOI: 10.1186/s12879-019-4275-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Biomedical interventions such as antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are highly effective for prevention of human immunodeficiency virus (HIV) infection. However, China has not released national PrEP guidelines, and HIV incidence among men who have sex with men (MSM) is unchanged despite substantial scale-up of ART. We evaluated reductions in HIV transmission that may be achieved through early initiation of ART plus partners' PrEP. METHODS Six intervention scenarios were evaluated in terms of their impact on HIV transmission and their cost-effectiveness for 36 months post-infection. Three scenarios were based on observed data: non-ART, standard-ART, and early-ART. Another three scenarios were based on observed and hypothetical data: non-ART plus partners' PrEP, standard-ART plus partners' PrEP, and early-ART plus partners' PrEP. The number of onward transmissions was calculated according to viral load and self-reported sexual behaviors, and calibrated by the prevalence and incidence of HIV among Chinese MSM. Cost-effectiveness outcomes were quality-adjusted life-years (QALYs) and cost-utility ratio (CUR). RESULTS The estimated number of onward transmissions by every 100 HIV-positive cases 36 months post-infection was 41.83 (95% credible interval: 30.75-57.69) in the non-ART scenario, 7.95 (5.85-10.95) in the early-ART scenario, and 0.79 (0.58-1.09) in the early-ART plus partners' PrEP scenario. Compared with non-ART, the early-ART and early-ART plus partners' PrEP scenarios were associated with an 81.0 and 98.1% reduction in HIV transmission, and had a CUR of $12,864/QALY and $16,817/QALY, respectively. CONCLUSIONS Integrated delivery of early ART and sexual partners' PrEP could nearly eliminate HIV transmission and reduce costs during the first 36 months of HIV infection. Our results suggest a feasible and cost-effective strategy for reversing the HIV epidemic among MSM in China.
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Affiliation(s)
- Qing-hai Hu
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001 China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003 China
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, NY USA
| | - Jun-jie Xu
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001 China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003 China
| | - Zhen-xing Chu
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001 China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003 China
| | - Jing Zhang
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001 China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003 China
| | - Hai-bo Ding
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001 China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003 China
| | - Xiao-xu Han
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001 China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003 China
| | - Yong-jun Jiang
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001 China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003 China
| | - Wen-qing Geng
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001 China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003 China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001 China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001 China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003 China
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Abstract
Background Donor funding for HIV/AIDS services is declining in Cambodia, and domestic resources need to be mobilized to sustain and expand these services. However, the cost of delivering HIV/AIDS services is not well studied in Cambodia. This study aims to assess the costs of delivering HIV/AIDS services, identify the major components of costs, and sources of funding. Methods Four of the six highest HIV burden provinces were selected at random for this study. Within each province, four health centers and two hospitals were selected for detailed data collection. A mix of top-down and bottom-up methods were used to assess the costs for HIV testing and antiretroviral therapy (ART) from the provider perspective. We assessed the differences in the quantity and prices of inputs between health facilities of the same type to identify cost-drivers. Results The average cost per visit for HIV testing was $8.92 at health centers and $14.03 at referral hospitals. Differences in the number of visits per staff were the primary determinant of differences in the cost per visit. First-line ART costed about $250 per patient per year, and the number of patients per staff was an important cost driver. Second-line ART costed from $500 to $716 per patient per year, on average, across the types of facilities, with the quantity and mix of second-line antiretroviral drugs being an important cost driver. Inpatient care at referral and provincial hospitals in total represented less than 2 percent of costs of outpatient ART. Discussion Costs are similar to neighboring countries, but over 50% of the costs of ART are financed by donors. Cambodia now is scaling up social health insurance coverage; the data from this study could serve as one input when setting reimbursement rates for HIV/AIDS services to help ensure that providers are adequately reimbursed for their services.
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Affiliation(s)
- Kouland Thin
- Health Division, Swiss Development Cooperation, Phnom Penh, Cambodia
- * E-mail:
| | - Virak Prum
- Department of Geography, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Benjamin Johns
- International Development Division, Abt Associates, Inc., Bethesda, Maryland, United States
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Adamson B, El-Sadr W, Dimitrov D, Gamble T, Beauchamp G, Carlson JJ, Garrison L, Donnell D. The Cost-Effectiveness of Financial Incentives for Viral Suppression: HPTN 065 Study. Value Health 2019; 22:194-202. [PMID: 30711064 PMCID: PMC6362462 DOI: 10.1016/j.jval.2018.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/15/2018] [Accepted: 09/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of financial incentives for human immunodeficiency virus (HIV) viral suppression compared to standard of care. STUDY DESIGN Mathematical model of 2-year intervention offering financial incentives ($70 quarterly) for viral suppression (<400 copies/ml3) based on the HPTN 065 clinical trial with HIV patients in the Bronx, NY and Washington, D.C. METHODS A disease progression model with HIV transmission risk equations was developed following guidelines from the Second Panel on Cost-Effectiveness in Health and Medicine. We used health care sector and societal perspectives, 3% discount rate, and lifetime horizon. Data sources included trial data (baseline N = 16,208 patients), CDC HIV Surveillance data, and published literature. Outcomes were costs (2017 USD), quality-adjusted life years (QALYs), HIV infections prevented, and incremental cost-effectiveness ratio (ICER). RESULTS Financial incentives for viral suppression were estimated to be cost-saving from a societal perspective and cost-effective ($49,877/QALY) from a health care sector perspective. Compared to the standard of care, financial incentives gain 0.06 QALYs and lower discounted lifetime costs by $4210 per patient. The model estimates that incentivized patients transmit 9% fewer infections than the standard-of-care patients. In the sensitivity analysis, ICER 95% credible intervals ranged from cost-saving to $501,610/QALY with 72% of simulations being cost-effective using a $150,000/QALY threshold. Modeling results are limited by uncertainty in efficacy from the clinical trial. CONCLUSIONS Financial incentives, as used in HTPN 065, are estimated to improve quality and length of life, reduce HIV transmissions, and save money from a societal perspective. Financial incentives offer a promising option for enhancing the benefits of medication in the United States.
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Affiliation(s)
- Blythe Adamson
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | | | - Dobromir Dimitrov
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Theresa Gamble
- HPTN Leadership and Operations Center, Science Facilitation Department, FHI 360, Durham, NC, USA
| | - Geetha Beauchamp
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Josh J Carlson
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Louis Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Deborah Donnell
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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20
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Steiner DJ. Pharmaceuticals and Medical Devices: Cost Savings. Issue Brief Health Policy Track Serv 2018; 2018:1-31. [PMID: 30695849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Goga AE, Singh Y, Singh M, Noveve N, Magasana V, Ramraj T, Abdullah F, Coovadia AH, Bhardwaj S, Sherman GG. Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings. Matern Child Health J 2018; 21:1-8. [PMID: 27514391 PMCID: PMC5226975 DOI: 10.1007/s10995-016-2074-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Increasing access to HIV-related care and treatment for children aged 0–18 years in resource-limited settings is an urgent global priority. In 2011–2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of results to facilities; (6) community leader and health worker advocacy at creches, schools, religious centres to increase uptake of HIV testing and dispel fatalistic beliefs about HIV; (7) use of mobile communication technology (m-health) and peer/community supporters to maintain contact with patients. Discussion and Conclusion We propose that this package of facility, community and family-orientated interventions are needed to change the trajectory of the paediatric HIV epidemic and its associated patterns of morbidity and mortality, thus achieving the double dividend of improving HIV-free survival.
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Affiliation(s)
- Ameena Ebrahim Goga
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa.
- Department of Paediatrics, University of Pretoria, Private bag X20, Hatfield, Pretoria, 0028, South Africa.
| | - Yagespari Singh
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa
| | - Michelle Singh
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa
| | - Nobuntu Noveve
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa
| | - Vuyolwethu Magasana
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa
| | - Trisha Ramraj
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa
| | | | - Ashraf H Coovadia
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Gayle G Sherman
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Institute of Communicable Diseases, National Health Laboratory Services, Modderfontein Road, Sandringham, Johannesburg, South Africa
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Maheswaran H, Petrou S, Cohen D, MacPherson P, Kumwenda F, Lalloo DG, Corbett EL, Clarke A. Economic costs and health-related quality of life outcomes of hospitalised patients with high HIV prevalence: A prospective hospital cohort study in Malawi. PLoS One 2018; 13:e0192991. [PMID: 29543818 PMCID: PMC5854246 DOI: 10.1371/journal.pone.0192991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/03/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction Although HIV infection and its associated co-morbidities remain the commonest reason for hospitalisation in Africa, their impact on economic costs and health-related quality of life (HRQoL) are not well understood. This information is essential for decision-makers to make informed choices about how to best scale-up anti-retroviral treatment (ART) programmes. This study aimed to quantify the impact of HIV infection and ART on economic outcomes in a prospective cohort of hospitalised patients with high HIV prevalence. Methods Sequential medical admissions to Queen Elizabeth Central Hospital, Malawi, between June-December 2014 were followed until discharge, with standardised classification of medical diagnosis and estimation of healthcare resources used. Primary costing studies estimated total health provider cost by medical diagnosis. Participants were interviewed to establish direct non-medical and indirect costs. Costs were adjusted to 2014 US$ and INT$. HRQoL was measured using the EuroQol EQ-5D. Multivariable analyses estimated predictors of economic outcomes. Results Of 892 eligible participants, 80.4% (647/892) were recruited and medical notes found. In total, 447/647 (69.1%) participants were HIV-positive, 339/447 (75.8%) were on ART prior to admission, and 134/647 (20.7%) died in hospital. Mean duration of admission for HIV-positive participants not on ART and HIV-positive participants on ART was 15.0 days (95%CI: 12.0–18.0) and 12.2 days (95%CI: 10.8–13.7) respectively, compared to 10.8 days (95%CI: 8.8–12.8) for HIV-negative participants. Mean total provider cost per hospital admission was US$74.78 (bootstrap 95%CI: US$25.41-US$124.15) higher for HIV-positive than HIV-negative participants. Amongst HIV-positive participants, the mean total provider cost was US$106.87 (bootstrap 95%CI: US$25.09-US$106.87) lower for those on ART than for those not on ART. The mean total direct non-medical and indirect cost per hospital admission was US$87.84. EQ-5D utility scores were lower amongst HIV-positive participants, but not significantly different between those on and not on ART. Conclusions HIV-related hospital care poses substantial financial burdens on health systems and patients; however, per-admission costs are substantially lower for those already initiated onto ART prior to admission. These potential cost savings could offset some of the additional resources needed to provide universal access to ART.
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Affiliation(s)
- Hendramoorthy Maheswaran
- Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Stavros Petrou
- Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
| | - Danielle Cohen
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter MacPherson
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Felistas Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - David G. Lalloo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elizabeth L. Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aileen Clarke
- Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
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Affiliation(s)
- Erika G Martin
- From the Rockefeller Institute of Government and the Department of Public Administration and Policy, University at Albany, State University of New York, Albany (E.G.M.); and the Department of Healthcare Policy and Administration, Weill Cornell Medical College, New York (B.R.S.)
| | - Bruce R Schackman
- From the Rockefeller Institute of Government and the Department of Public Administration and Policy, University at Albany, State University of New York, Albany (E.G.M.); and the Department of Healthcare Policy and Administration, Weill Cornell Medical College, New York (B.R.S.)
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Ong KJ, Desai S, Field N, Desai M, Nardone A, van Hoek AJ, Gill ON. Economic evaluation of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016. Euro Surveill 2017; 22:17-00192. [PMID: 29067902 PMCID: PMC5710117 DOI: 10.2807/1560-7917.es.2017.22.42.17-00192] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/15/2017] [Indexed: 12/18/2022] Open
Abstract
Clinical effectiveness of pre-exposure prophylaxis (PrEP) for preventing HIV acquisition in men who have sex with men (MSM) at high HIV risk is established. A static decision analytical model was constructed to inform policy prioritisation in England around cost-effectiveness and budgetary impact of a PrEP programme covering 5,000 MSM during an initial high-risk period. National genitourinary medicine clinic surveillance data informed key HIV risk assumptions. Pragmatic large-scale implementation scenarios were explored. At 86% effectiveness, PrEP given to 5,000 MSM at 3.3 per 100 person-years annual HIV incidence, assuming risk compensation (20% HIV incidence increase), averted 118 HIV infections over remaining lifetimes and was cost saving. Lower effectiveness (64%) gave an incremental cost-effectiveness ratio of + GBP 23,500 (EUR 32,000) per quality-adjusted life year (QALY) gained. Investment of GBP 26.9 million (EUR 36.6 million) in year-1 breaks even anywhere from year-23 (86% effectiveness) to year-33 (64% effectiveness). PrEP cost-effectiveness was highly sensitive to year-1 HIV incidence, PrEP adherence/effectiveness, and antiretroviral drug costs. There is much uncertainty around HIV incidence in those given PrEP and adherence/effectiveness, especially under programme scale-up. Substantially reduced PrEP drug costs are needed to give the necessary assurance of cost-effectiveness, and for an affordable public health programme of sufficient size.
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Affiliation(s)
- Koh Jun Ong
- HIV & STI Department, National Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Sarika Desai
- HIV & STI Department, National Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Nigel Field
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Monica Desai
- HIV & STI Department, National Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | - Anthony Nardone
- HIV & STI Department, National Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
| | | | - Owen Noel Gill
- HIV & STI Department, National Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
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Juneja S, Gupta A, Moon S, Resch S. Projected savings through public health voluntary licences of HIV drugs negotiated by the Medicines Patent Pool (MPP). PLoS One 2017; 12:e0177770. [PMID: 28542239 PMCID: PMC5444652 DOI: 10.1371/journal.pone.0177770] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 05/03/2017] [Indexed: 11/19/2022] Open
Abstract
The Medicines Patent Pool (MPP) was established in 2010 to ensure timely access to low-cost generic versions of patented antiretroviral (ARV) medicines in low- and middle-income countries (LMICs) through the negotiation of voluntary licences with patent holders. While robust data on the savings generated by MPP and other major global public health initiatives is important, it is also difficult to quantify. In this study, we estimate the savings generated by licences negotiated by the MPP for ARV medicines to treat HIV/AIDS in LMICs for the period 2010–2028 and generate a cost-benefit ratio–based on people living with HIV (PLHIVs) in any new countries which gain access to an ARV due to MPP licences and the price differential between originator’s tiered price and generics price, within the period where that ARV is patented. We found that the direct savings generated by the MPP are estimated to be USD 2.3 billion (net present value) by 2028, representing an estimated cost-benefit ratio of 1:43, which means for every USD 1 spent on MPP, the global public health community saves USD 43. The saving of USD 2.3 billion is equivalent to more than 24 million PLHIV receiving first-line ART in LMICs for 1 year at average prices today.
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Affiliation(s)
| | - Aastha Gupta
- Medicines Patent Pool, Geneva, Switzerland
- * E-mail:
| | - Suerie Moon
- Harvard T.H. Chan School of Public Health, Boston, United States of America
| | - Stephen Resch
- Harvard T.H. Chan School of Public Health, Boston, United States of America
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Shattock AJ, Benedikt C, Bokazhanova A, Đurić P, Petrenko I, Ganina L, Kelly SL, Stuart RM, Kerr CC, Vinichenko T, Zhang S, Hamelmann C, Manova M, Masaki E, Wilson DP, Gray RT. Kazakhstan can achieve ambitious HIV targets despite expected donor withdrawal by combining improved ART procurement mechanisms with allocative and implementation efficiencies. PLoS One 2017; 12:e0169530. [PMID: 28207809 PMCID: PMC5313190 DOI: 10.1371/journal.pone.0169530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 12/19/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Despite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels. METHODOLOGY We used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure-two areas identified for potential cost-reductions. We determined optimal allocations across HIV programs to satisfy either national targets or ambitious targets. For each scenario, we considered two cases of future HIV financing: the 2014 national budget maintained into the future and the 2014 budget without current international investment. FINDINGS Kazakhstan can achieve its national HIV targets with the current budget by (1) optimally re-allocating resources across programs and (2) either securing a 35% [30%-39%] reduction in antiretroviral treatment drug costs or reducing management costs by 44% [36%-58%] of 2014 levels. Alternatively, a combination of antiretroviral treatment and management cost-reductions could be sufficient. Furthermore, Kazakhstan can achieve ambitious targets of halving new infections and AIDS-related deaths by 2020 compared to 2014 levels by attaining a 67% reduction in antiretroviral treatment costs, a 19% [14%-27%] reduction in management costs, and allocating resources optimally. SIGNIFICANCE With Kazakhstan facing impending donor withdrawal, it is important for the HIV response to achieve more with available resources. This analysis can help to guide HIV response planners in directing available funding to achieve the greatest yield from investments. The key changes recommended were considered realistic by Kazakhstan country representatives.
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Affiliation(s)
| | | | | | - Predrag Đurić
- United Nations Development Programme, Istanbul Regional Hub, Istanbul, Turkey
| | - Irina Petrenko
- Republican Center for Prevention and Control of AIDS, Almaty, Kazakhstan
| | - Lolita Ganina
- Republican Center for Prevention and Control of AIDS, Almaty, Kazakhstan
| | | | - Robyn M. Stuart
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cliff C. Kerr
- The Kirby Institute, University of New South Wales, Sydney, Australia
- School of Physics, University of Sydney, Sydney, Australia
| | - Tatiana Vinichenko
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Shufang Zhang
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Christoph Hamelmann
- United Nations Development Programme, Istanbul Regional Hub, Istanbul, Turkey
| | - Manoela Manova
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Emiko Masaki
- The World Bank Group, Washington DC, United States of America
| | - David P. Wilson
- The Kirby Institute, University of New South Wales, Sydney, Australia
- The Burnet Institute, Melbourne, Australia
| | - Richard T. Gray
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Greene E, Pack A, Stanton J, Shelus V, Tolley EE, Taylor J, El Sadr WM, Branson BM, Leider J, Rakhmanina N, Gamble T. "It Makes You Feel Like Someone Cares" acceptability of a financial incentive intervention for HIV viral suppression in the HPTN 065 (TLC-Plus) study. PLoS One 2017; 12:e0170686. [PMID: 28182706 PMCID: PMC5300168 DOI: 10.1371/journal.pone.0170686] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/09/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HPTN 065 (TLC-Plus) evaluated the feasibility and effectiveness of providing quarterly $70 gift card financial incentives to HIV-infected patients on antiretroviral therapy (ART) to encourage ART adherence and viral suppression, and represents the largest study to-date of a financial incentive intervention for HIV viral suppression. A post-trial qualitative substudy was undertaken to examine acceptability of the financial incentives among those receiving and implementing the intervention. METHODS Between July and October 2013, semi-structured interviews were conducted with 72 patients and 12 investigators from 14 sites; three focus groups were conducted with 12 staff from 10 sites. Qualitative data collection elicited experiences with and attitudes about the intervention, including philosophical viewpoints and implementation experiences. Transcripts were analyzed in NVivo 10. Memos and matrices were developed to explore themes from different participant group perspectives. RESULTS Patients, investigators, and staff found the intervention highly acceptable, primarily due to the emotional benefits gained through giving or receiving the incentive. Feeling rewarded or cared for was a main value perceived by patients; this was closely tied to the financial benefit for some. Other factors influencing acceptability for all included perceived effectiveness and health-related benefits, philosophical concerns about the use of incentives for health behavior change, and implementation issues. The termination of the incentive at the end of the study was disappointing to participants and unexpected by some, but generally accepted. CONCLUSION Positive experiences with the financial incentive intervention and strategies used to facilitate implementation led to high acceptability of the intervention, despite some reluctance in principle to the use of incentives. The findings of this analysis provide encouraging evidence in support of the acceptability of a large-scale financial incentive intervention for HIV viral suppression in a clinical setting, and offer valuable lessons for future applications of similar interventions.
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Affiliation(s)
- Elizabeth Greene
- Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America
- * E-mail:
| | - Allison Pack
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jill Stanton
- Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America
| | - Victoria Shelus
- Institute for Reproductive Health, Georgetown University, Washington DC, United States of America
| | - Elizabeth E. Tolley
- Social and Behavioral Health Sciences, FHI 360, Durham, North Carolina, United States of America
| | - Jamilah Taylor
- Social and Behavioral Health Sciences, FHI 360, Durham, North Carolina, United States of America
| | - Wafaa M. El Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, United States of America
| | | | - Jason Leider
- Jacobi Medical Center, New York, New York, United States of America
| | - Natella Rakhmanina
- Children’s National Health System, Washington DC, United States of America
- Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
| | - Theresa Gamble
- Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America
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Modisenyane SM, Hendricks SJH, Fineberg H. Understanding how domestic health policy is integrated into foreign policy in South Africa: a case for accelerating access to antiretroviral medicines. Glob Health Action 2017; 10:1339533. [PMID: 28685669 PMCID: PMC5533135 DOI: 10.1080/16549716.2017.1339533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/21/2017] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND South Africa, as an emerging middle-income country, is becoming increasingly influential in global health diplomacy (GHD). However, little empirical research has been conducted to inform arguments for the integration of domestic health into foreign policy by state and non-state actors. This study seeks to address this knowledge gap. It takes the form of an empirical case study which analyses how South Africa integrates domestic health into its foreign policy, using the lens of access to antiretroviral (ARV) medicines. OBJECTIVE To explore state and non-state actors' perceptions regarding how domestic health policy is integrated into foreign policy. The ultimate goal of this study was to achieve better insights into the health and foreign policy processes at the national level. METHODS Employing qualitative approaches, we examined changes in the South African and global AIDS policy environment. Purposive sampling was used to select key informants, a sample of state and non-state actors who participated in in-depth interviews. Secondary data were collected through a systematic literature review of documents retrieved from five electronic databases, including review of key policy documents. Qualitative data were analysed for content. This content was coded, and the codes were collated into tentative categories and sub-categories using Atlas.ti v.7 software. RESULTS The findings of this work illustrate the interplay among social, political, economic and institutional conditions in determining the success of this integration process. Our study shows that a series of national and external developments, stakeholders, and advocacy efforts and collaboration created these integrative processes. South Africa's domestic HIV/AIDS constituencies, in partnership with the global advocacy movement, catalysed the mobilization of support for universal access to ARV treatment nationally and globally, and the promotion of access to healthcare as a human right. CONCLUSIONS Transnational networks may influence government's decision making by providing information and moving issues up the agenda.
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Affiliation(s)
- Simon Moeketsi Modisenyane
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | | | - Harvey Fineberg
- President of Gordon and Betty Moore Foundation, Palo Alto, CA, USA
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Etiaba E, Onwujekwe O, Torpey K, Uzochukwu B, Chiegil R. What Is the Economic Burden of Subsidized HIV/AIDS Treatment Services on Patients in Nigeria and Is This Burden Catastrophic to Households? PLoS One 2016; 11:e0167117. [PMID: 27911921 PMCID: PMC5135056 DOI: 10.1371/journal.pone.0167117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 11/09/2016] [Indexed: 11/23/2022] Open
Abstract
Background A gap in knowledge exists regarding the economic burden on households of subsidized anti-retroviral treatment (ART) programs in Nigeria. This is because patients also incur non-ART drug costs, which may constrain the delivery and utilisation of subsidized services. Methods An exit survey of adults (18+years) attending health facilities for HIV/AIDS treatment was conducted in three states in Nigeria (Adamawa, Akwa Ibom and Anambra). In the states, ART was fully subsidized but there were different payment modalities for other costs of treatment. Data was collected and analysed for direct and indirect costs of treatment of HIV/AIDS and co-morbidities’ during out-and in-patient visits. The levels of catastrophic health expenditure (CHE) were computed and disaggregated by state, socio-economic status (SES) and urban-rural location of the respondents. Catastrophic Health Expenditure (CHE) in this study measures the number of respondents whose monthly ART-related household expenditure (for in-patient and out-patient visits) as a proportion of monthly non-food expenditure was greater than 40% and 10% respectively. Results The average out-patient and in-patient direct costs were $5.49 and $122.10 respectively. Transportation cost was the highest non-medical cost and it was higher than most medical costs. The presence of co-morbidities contributed to household costs. All the costs were catastrophic to households at 10% and 40% thresholds in the three states, to varying degrees. The poorest SES quintile had the highest incidence of CHE for out-patient costs (p<0.0001). Rural dwellers incurred more CHE for all categories of costs compared to urban dwellers, but the costs were statistically significant for only outpatient costs. Conclusion ART subsidization is not enough to eliminate economic burden of treatment on HIV patients. Service decentralization to reduce travel costs, and subsidy on other components of HIV treatment services should be introduced to eliminate the persisting inequitable and high cost burden of ART services. Full inclusion of ART services within the benefit package of the National Health Insurance Scheme should be considered.
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Affiliation(s)
- Enyi Etiaba
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Health Policy Research Group, Department of Pharmacology and Pharmaco-Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- * E-mail:
| | - Obinna Onwujekwe
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Health Policy Research Group, Department of Pharmacology and Pharmaco-Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Kwasi Torpey
- Strengthening Integrated delivery for HIV/AIDS services (SIDHAS), FHI 360, Plot 1073 J.S. Tarka Street, Garki, P.M.B, Abuja, Nigeria
| | - Benjamin Uzochukwu
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Health Policy Research Group, Department of Pharmacology and Pharmaco-Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Robert Chiegil
- Strengthening Integrated delivery for HIV/AIDS services (SIDHAS), FHI 360, Plot 1073 J.S. Tarka Street, Garki, P.M.B, Abuja, Nigeria
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Guennif S. Evaluating the Usefulness of Compulsory Licensing in Developing Countries: A Comparative Study of Thai and Brazilian Experiences Regarding Access to Aids Treatments. Dev World Bioeth 2016; 17:90-99. [PMID: 27699996 DOI: 10.1111/dewb.12124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
While compulsory licensing (CL) is described in the TRIPS agreement as flexibility to protect public health by improving access to medicines in developing countries, a recent literature contends adversely that CL may harm public health. Therefore, this article intends to evaluate the usefulness of CL in the South through the prism of obligations and goals entrusted to patent holders (the effective and non-abusive exploitation of patents in order to achieve industrial and health developments) and in light of experiences in Thailand and Brazil regarding access to antiretroviral drugs. In this way, it shows that the obligations assigned to patent holders were better served by the recipients of CL and brought significant health and industrial benefits in the two high middle-income countries. In particular, CL allowed the scaling-up of free and universal access to antiretroviral drugs by assuring the financial sustainability of these public health programs endangered by monopolistic practices from patent holders.
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Abstract
Many countries with financial support for HIV treatment experience delays in scale-up because of bureaucratic, operational, and technical obstacles. The authors describe the Peruvian National HIV Program's response to such challenges. A team of consultants experienced in the scale-up of the Peruvian national program to treat multidrug-resistant tuberculosis worked with the national HIV program to identify and address key factors contributing to slow enrollment of HIV patients into the antiretroviral treatment program. The rate of enrollment into the antiretroviral treatment program increased from 124 patients/month in the first 9 months of the program to 226 patients/month in the last 7 months, an increase of 83%. This strategy achieved 38.5% coverage of the population in need. Effective programmatic expansion of the Peruvian National HIV Program was facilitated by a multidisciplinary collaboration in a systematized effort to overcome barriers to scale-up.
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Llibre JM, de Lazzari E, Molina JM, Gallien S, Gonzalez-García J, Imaz A, Podzamczer D, Clotet B, Domingo P, Gatell JM. Cost-effectiveness of initial antiretroviral treatment administered as single vs. multiple tablet regimens with the same or different components. Enferm Infecc Microbiol Clin 2016; 36:16-20. [PMID: 27595183 DOI: 10.1016/j.eimc.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the efficiency of single-tablet regimens (STR) and multiple-tablet regimens (MTR) with exactly the same or different components. METHODS A study was conducted on HIV-1-infected antiretroviral-naïve patients from 6 Spanish or French centers, who were started on treatment with STR-Atripla®, or the same components separately (MTR-SC), or a different MTR (MTR-Other). Effectiveness was measured as percentage of HIV-RNA <50copies/mL at 48 weeks (ITT). Efficiency was the ratio between costs (direct cost of antiretrovirals plus outpatient visits, hospital admissions, and resistance tests) and effectiveness. RESULTS The study included a total of 2773 patients (759 STR-Atripla®, 483 MTR-SC, and 1531 MTR-Other). Median age was 37 years, 15% were HCV co-infected, 27% had a CD4+ count <200cells/μL, and 30% had viral load ≥100.000copies/mL. The duration of the assigned treatment was longer for STR-Atripla® (P<.0001). Response rates (adjusted for CD4+ count, viral load, and clustered on hospitals) at 48 weeks were 76%, 74%, and 62%, respectively (P<.0001). Virological failure was more common in MTR patients (P=.0025), and interruptions due to intolerance with MTR-Other (P<.0001). Cost per responder at 48 weeks (efficiency) was €12,406 with STR-Atripla®, €11,034 with MTR-SC (0.89 [0.82, 0.99] times lower), and €18,353 (1.48 [1.38, 1.61] times higher) with MTR-Other. CONCLUSIONS STR-Atripla® and MTR-SC regimens showed similar effectiveness, but virological failure rate was lower with STR-Atripla. MTR-SC, considered less convenient, had a marginally better efficiency, mainly due to lower direct costs. MTR-Other regimens had both a worse effectiveness and efficiency. Similar efficiency analyses adjusting for baseline characteristics should be recommended for new STRs.
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Affiliation(s)
- Josep M Llibre
- Infectious Diseases Department and "Lluita contra la SIDA" Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona, Spain.
| | - Elisa de Lazzari
- Fundació Clinic per a la Recerca Biomèdica, Hospital Clinic/IDIBAPS, Barcelona, Spain
| | - Jean-Michel Molina
- Infectious Diseases, St. Louis Hospital, Paris Diderot University, Paris, France
| | - Sébastien Gallien
- Infectious Diseases, St. Louis Hospital, Paris Diderot University, Paris, France
| | | | - Arkaitz Imaz
- HIV Unit, Infectious Disease Service, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - Daniel Podzamczer
- HIV Unit, Infectious Disease Service, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - Bonaventura Clotet
- Infectious Diseases Department and "Lluita contra la SIDA" Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona, Spain; UAB, UVIC-UCC, IEC, Spain
| | | | - Josep M Gatell
- Infectious Diseases & AIDS Units, Hospital Clinic/IDIBAPS, University of Barcelona, Barcelona, Spain
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Abstract
Much of the current health approach to designing HIV/AIDS interventions in resource-poor settings involves behavior-change initiatives, particularly those adopting education-based and “culturally competent” frameworks for the reduction of HIV-associated “risk behaviors.” This article reviews the evidence and social assumptions behind this approach to preventing HIV transmission, and argues that these approaches are often inadequate or misguided, particularly in their conflation of the concept of “culture” with social circumstances. By analyzing the socioeconomic circumstances that constrain individual agency, and by combining data from prevention literature with analyses of international trade agreements and the controversies over antiretroviral drug distribution, the author argues that the movement of capital and the maintenance of inequality are central to the problems associated with behavior-change initiatives and must be addressed through new paradigms in order to respond appropriately to the global AIDS pandemic. Hardt and Negri's paradigm of “Empire”—that is, examining the system through which social inequalities are maintained not only between countries but also within them—offers prospects for the design of new interventions and targets for public health workers and social movements.
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Affiliation(s)
- Sanjay Basu
- Program in Infectious Disease and Social Change, Yale University School of Medicine, New Haven, CT 06510, USA.
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Sapsirisavat V, Vongsutilers V, Thammajaruk N, Pussadee K, Riyaten P, Kerr S, Avihingsanon A, Phanuphak P, Ruxrungtham K. Pharmaceutical Equivalence of Distributed Generic Antiretroviral (ARV) in Asian Settings: The Cross-Sectional Surveillance Study - PEDA Study. PLoS One 2016; 11:e0157039. [PMID: 27322409 PMCID: PMC4913952 DOI: 10.1371/journal.pone.0157039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 05/24/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Ensuring that medicines meet quality standards is mandatory for ensuring safety and efficacy. There have been occasional reports of substandard generic medicines, especially in resource-limiting settings where policies to control quality may be less rigorous. As HIV treatment in Thailand depends mostly on affordable generic antiretrovirals (ARV), we performed quality assurance testing of several generic ARV available from different sources in Thailand and a source from Vietnam. METHODS We sampled Tenofovir 300mg, Efavirenz 600mg and Lopinavir/ritonavir 200/50mg from 10 primary hospitals randomly selected from those participating in the National AIDS Program, 2 non-government organization ARV clinics, and 3 private drug stores. Quality of ARV was analyzed by blinded investigators at the Faculty of Pharmaceutical Science, Chulalongkorn University. The analysis included an identification test for drug molecules, a chemical composition assay to quantitate the active ingredients, a uniformity of mass test and a dissolution test to assess in-vitro drug release. Comparisons were made against the standards described in the WHO international pharmacopeia. RESULTS A total of 42 batches of ARV from 15 sources were sampled from January-March 2015. Among those generics, 23, 17, 1, and 1 were Thai-made, Indian-made, Vietnamese-made and Chinese-made, respectively. All sampled products, regardless of manufacturers or sources, met the International Pharmacopeia standards for composition assay, mass uniformity and dissolution. Although local regulations restrict ARV supply to hospitals and clinics, samples of ARV could be bought from private drug stores even without formal prescription. CONCLUSION Sampled generic ARVs distributed within Thailand and 1 Vietnamese pharmacy showed consistent quality. However some products were illegally supplied without prescription, highlighting the importance of dispensing ARV for treatment or prevention in facilities where continuity along the HIV treatment and care cascade is available.
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Affiliation(s)
- Vorapot Sapsirisavat
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
| | - Vorasit Vongsutilers
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Narukjaporn Thammajaruk
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
| | - Kanitta Pussadee
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
| | - Prakit Riyaten
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
| | - Stephen Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute of Global Health and Development, Trinity Building C, Pietersbergweg 17, 1105 BM, Amsterdam Zuidoost, The Netherlands
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, 254 Phyathai Road, Pathumwan, Bangkok, Thailand
| | - Praphan Phanuphak
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, 254 Phyathai Road, Pathumwan, Bangkok, Thailand
| | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, 254 Phyathai Road, Pathumwan, Bangkok, Thailand
- * E-mail:
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Treskova M, Kuhlmann A, Bogner J, Hower M, Heiken H, Stellbrink HJ, Mahlich J, von der Schulenburg JMG, Stoll M. Analysis of contemporary HIV/AIDS health care costs in Germany: Driving factors and distribution across antiretroviral therapy lines. Medicine (Baltimore) 2016; 95:e3961. [PMID: 27367993 PMCID: PMC4937907 DOI: 10.1097/md.0000000000003961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To analyze contemporary costs of HIV health care and the cost distribution across lines of combination antiretroviral therapy (cART). To identify variations in expenditures with patient characteristics and to identify main cost determinants. To compute cost ratios between patients with varying characteristics.Empirical data on costs are collected in Germany within a 2-year prospective observational noninterventional multicenter study. The database contains information for 1154 HIV-infected patients from 8 medical centers.Means and standard deviations of the total costs are estimated for each cost fraction and across cART lines and regimens. The costs are regressed against various patient characteristics using a generalized linear model. Relative costs are calculated using the resultant coefficients.The average annual total costs (SD) per patient are &OV0556;22,231.03 (8786.13) with a maximum of &OV0556;83,970. cART medication is the major cost fraction (83.8%) with a mean of &OV0556;18,688.62 (5289.48). The major cost-driving factors are cART regimen, CD4-T cell count, cART drug resistance, and concomitant diseases. Viral load, pathology tests, and demographics have no significant impact. Standard non-nucleoside reverse transcriptase inhibitor-based regimens induce 28% lower total costs compared with standard PI/r regimens. Resistance to 3 or more antiretroviral classes induces a significant increase in costs.HIV treatment in Germany continues to be expensive. Majority of costs are attributable to cART. Main cost determinants are CD4-T cells count, comorbidity, genotypic antiviral resistance, and therapy regimen. Combinations of characteristics associated with higher expenditures enhance the increasing effect on the costs and induce high cost cases.
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Affiliation(s)
- Marina Treskova
- Center for Health Economics Research Hannover, Hannover
- Correspondence: Marina Treskova, Gottfried Wilhelm Leibniz Universität Hannover, Center for Health Economics Research Hannover Institut für Versicherungsbetriebslehre Otto-Brenner-Str. 1, 30159 Hannover, Germany (e-mail: )
| | | | - Johannes Bogner
- Sektion Klinische Infektiologie, Med IV, Klinikum der Universität München, Munich
| | - Martin Hower
- ID-Ambulanz der Medizinischen Klinik Nord, Klinikum Dortmund, Dortmund
| | - Hans Heiken
- Innere Medizin, Praxis Georgstraße, Hannover
| | | | - Jörg Mahlich
- Health Economics & Pricing, Janssen-Cilag GmbH, Neuss
| | | | - Matthias Stoll
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Germany
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David PM. Measurement, "scriptural economies," and social justice: governing HIV/AIDS treatments by numbers in a fragile state, the Central African Republic (CAR). Dev World Bioeth 2016; 17:32-39. [PMID: 26841345 DOI: 10.1111/dewb.12107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fragile states have been raising increasing concern among donors since the mid-2000s. The policies of the Global Fund to fight HIV/AIDS, Malaria, and Tuberculosis (GF) have not excluded fragile states, and this source has provided financing for these countries according to standardized procedures. They represent interesting cases for exploring the meaning and role of measurement in a globalized context. Measurement in the field of HIV/AIDS and its treatment has given rise to a private outsourcing of expertise and auditing, thereby creating a new form of value based on the social process of registration and the creation of realities produced by the intervention itself. These "scriptural economies" must be questioned in terms of the production of knowledge, but also in terms of social justice. Governing HIV/AIDS treatments by numbers in a fragile state is explored in this article through the experience of the Central African Republic (CAR) in terms of epidemiology and access to antiretroviral drugs. The unexpected effects of performance-based programs in this context underline the need for global health governance to be re-embedded into a social justice framework.
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Effingham AM. TRIPS AGREEMENT ARTICLE 31(B): THE NEED FOR REVISION. Seton Hall Law Rev 2016; 46:883-909. [PMID: 27066613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Dou Z, Zhang F, Zhao Y, Jin C, Zhao D, Gan X, Ma Y. [Progress on China' s national free antiretroviral therapy strategy in 2002-2014]. Zhonghua Liu Xing Bing Xue Za Zhi 2015; 36:1345-1350. [PMID: 26850386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To analyze the progress and characteristics of China' s "Free AIDS treatment strategy" since the implementation of the national "four free and one care" policy against AIDS 12 years ago. METHODS Retrospective cohort study and cross-sectional analysis had been conducted in this study. 368 449 cases that had received the ' free antiviral therapy' from 2002 to 2014 were selected from the National Treatment Database. Data from the baseline (initial time of ART, CD(4) cell count, and antiretroviral regimen) and from the follow-up program (dates and status of follow-up, CD(4) cell counts) were gathered and analysed by SAS 9.3. RESULTS The number of cases that having received new treatment was increasing year by year, accounting for 75.4% of all the cases identified from 2010 to 2014. Constituent ratios of patients with baseline CD(4) cell count <200 cells/µl and clinical diagnosis of AIDS were decreasing from 81.0% in 2006 to 39.7 % in 2014. Status on drug optimization showed that: 3TC replaced DDI, EFV replaced NVP and TDF replaced D4T, making the utilization rates as 99.5%, 75.7%, and 60.6%, respectively, by 2014. Regions that were covered by the treatment accounted for 75.4% of all the counties/districts involved. The previous CDC-led AIDS treatment program and mode of management had been transferred to the hospital-based model. Proportion on the twice-CD(4)-testing model had been 75.2% since 2010, with the rate of virological detection increased from 70.8% in 2010 to 87.4% in 2014 and the virological unsuccessful testing rate decreased from 17.6% in 2010 to 11.8% in 2014. Among all the patients, the 1, 5 and 10 year survival rates appeared as 92.2%, 80.5% and 69.6%, respectively. For patients with baseline CD(4) cell counts as <50 cells/µl or >350 cells/µl, the corresponding survival rates showed as 81.6% , 69.9% , 60.9% and 97.9%, 89.8% , 81.0%, respectively. CONCLUSION China' s HIV/AIDS free antiretroviral therapy program appeared as a national treatment cohort which involved large number of participants, with new patients joining in, annually. Criterion on drug optimization and treatment were consistently following the recommendation and guidelines set by WHO. Management program on treatment had gradually turned to hospital-based, with follow-up and laboratory testing programs guaranteed, ended up with satisfactory treatment effects.
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Affiliation(s)
- Zhihui Dou
- National Center for AIDS/ STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Fujie Zhang
- National Center for AIDS/ STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Beijing Ditan Hospital, Capital Medical University
| | - Yan Zhao
- National Center for AIDS/ STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Canrui Jin
- National Center for AIDS/ STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Decai Zhao
- National Center for AIDS/ STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Xiumin Gan
- National Center for AIDS/ STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Ye Ma
- National Center for AIDS/ STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China;
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Kessler J, Nucifora K, Li L, Uhler L, Braithwaite S. Impact and Cost-Effectiveness of Hypothetical Strategies to Enhance Retention in Care within HIV Treatment Programs in East Africa. Value Health 2015; 18:946-955. [PMID: 26686778 PMCID: PMC4696404 DOI: 10.1016/j.jval.2015.09.2940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/21/2015] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Attrition from care among HIV infected patients can lead to poor clinical outcomes. Our objective was to evaluate hypothetical interventions seeking to improve retention-in-care (RIC) for HIV-infected patients in East Africa, asking whether they could offer favorable value compared to earlier ART initiation. METHODS We used a micro-simulation model to analyze two RIC focused strategies within an East African HIV treatment program--"risk reduction," defined as intervention(s) that decrease the risk of attrition from care; and "outreach," defined as interventions that find patients and relink them with care. We compared this to earlier ART treatment as a measure of the potential health benefits forgone (e.g., opportunity cost). RESULTS Reducing attrition by 40% at an average cost of $10 per person remains a less efficient use of resources compared to ensuring full access to ART (cost- effectiveness ratio $1300 vs $3700) for ART eligible patients. An outreach intervention had limited clinical benefit in our simulation. If intervention costs are <$10 per person, however, an intervention able to achieve a 40% (or greater) reduction in attrition may be a cost-effective next implementation option following implementation of earlier ART treatment. CONCLUSIONS Our results suggest that programs should consider retention focused programs once they have already achieved high degrees of ART coverage among eligible patients. It is important that decision makers understand the epidemiology and associated outcomes of those patients who are classified as lost to follow up in their systems prior to implementation in order to achieve the highest value.
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Affiliation(s)
- Jason Kessler
- Department of Population Health, New York University School of Medicine, New York, NY, USA.
| | - Kimberly Nucifora
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Lingfeng Li
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Lauren Uhler
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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Bor J, Rosen S, Chimbindi N, Haber N, Herbst K, Mutevedzi T, Tanser F, Pillay D, Bärnighausen T. Mass HIV Treatment and Sex Disparities in Life Expectancy: Demographic Surveillance in Rural South Africa. PLoS Med 2015; 12:e1001905; discussion e1001905. [PMID: 26599699 PMCID: PMC4658174 DOI: 10.1371/journal.pmed.1001905] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/15/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Women have better patient outcomes in HIV care and treatment than men in sub-Saharan Africa. We assessed--at the population level--whether and to what extent mass HIV treatment is associated with changes in sex disparities in adult life expectancy, a summary metric of survival capturing mortality across the full cascade of HIV care. We also determined sex-specific trends in HIV mortality and the distribution of HIV-related deaths in men and women prior to and at each stage of the clinical cascade. METHODS AND FINDINGS Data were collected on all deaths occurring from 2001 to 2011 in a large population-based surveillance cohort (52,964 women and 45,688 men, ages 15 y and older) in rural KwaZulu-Natal, South Africa. Cause of death was ascertained by verbal autopsy (93% response rate). Demographic data were linked at the individual level to clinical records from the public sector HIV treatment and care program that serves the region. Annual rates of HIV-related mortality were assessed for men and women separately, and female-to-male rate ratios were estimated in exponential hazard models. Sex-specific trends in adult life expectancy and HIV-cause-deleted adult life expectancy were calculated. The proportions of HIV deaths that accrued to men and women at different stages in the HIV cascade of care were estimated annually. Following the beginning of HIV treatment scale-up in 2004, HIV mortality declined among both men and women. Female adult life expectancy increased from 51.3 y (95% CI 49.7, 52.8) in 2003 to 64.5 y (95% CI 62.7, 66.4) in 2011, a gain of 13.2 y. Male adult life expectancy increased from 46.9 y (95% CI 45.6, 48.2) in 2003 to 55.9 y (95% CI 54.3, 57.5) in 2011, a gain of 9.0 y. The gap between female and male adult life expectancy doubled, from 4.4 y in 2003 to 8.6 y in 2011, a difference of 4.3 y (95% CI 0.9, 7.6). For women, HIV mortality declined from 1.60 deaths per 100 person-years (95% CI 1.46, 1.75) in 2003 to 0.56 per 100 person-years (95% CI 0.48, 0.65) in 2011. For men, HIV-related mortality declined from 1.71 per 100 person-years (95% CI 1.55, 1.88) to 0.76 per 100 person-years (95% CI 0.67, 0.87) in the same period. The female-to-male rate ratio for HIV mortality declined from 0.93 (95% CI 0.82-1.07) in 2003 to 0.73 (95% CI 0.60-0.89) in 2011, a statistically significant decline (p = 0.046). In 2011, 57% and 41% of HIV-related deaths occurred among men and women, respectively, who had never sought care for HIV in spite of the widespread availability of free HIV treatment. The results presented here come from a poor rural setting in southern Africa with high HIV prevalence and high HIV treatment coverage; broader generalizability is unknown. Additionally, factors other than HIV treatment scale-up may have influenced population mortality trends. CONCLUSIONS Mass HIV treatment has been accompanied by faster declines in HIV mortality among women than men and a growing female-male disparity in adult life expectancy at the population level. In 2011, over half of male HIV deaths occurred in men who had never sought clinical HIV care. Interventions to increase HIV testing and linkage to care among men are urgently needed.
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Affiliation(s)
- Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Africa Centre for Population Health, Mtubatuba, South Africa
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Noah Haber
- Africa Centre for Population Health, Mtubatuba, South Africa
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Kobus Herbst
- Africa Centre for Population Health, Mtubatuba, South Africa
| | | | - Frank Tanser
- Africa Centre for Population Health, Mtubatuba, South Africa
| | - Deenan Pillay
- Africa Centre for Population Health, Mtubatuba, South Africa
- Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Till Bärnighausen
- Africa Centre for Population Health, Mtubatuba, South Africa
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Andreoni M, Marcotullio S, Puro V, De Carli G, Tambussi G, Nozza S, Gori A, Rusconi S, Santoro MM, Clementi M, Perno CF, d'Arminio Monforte A, Maggiolo F, Castagna A, De Luca A, Galli M, Giacomelli A, Borderi M, Guaraldi G, Calcagno A, Di Perri G, Bonora S, Mussini C, Di Biagio A, Puoti M, Bruno R, Zuccaro V, Antinori A, Cinque P, Croce D, Restelli U, Rizzardini G, Lazzarin A. An update on integrase inhibitors: new opportunities for a personalized therapy? The NEXTaim Project. New Microbiol 2015; 38:443-490. [PMID: 26571377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/20/2015] [Indexed: 06/05/2023]
Abstract
Thanks to the development of antiretroviral agents to control HIV replication, HIV infection has turned from a fatal disease into a treatable chronic infection. The present work collects the opinions of several experts on the efficacy and safety of recently approved second generation of integrase inhibitors and, in particular, on the role of this new class of drugs in antiretroviral therapy. The availability of new therapeutic options represents an opportunity to ameliorate the efficacy of cART in controlling HIV replication also within viral reservoirs. The personalization of the treatment driven mainly by the management of comorbidities, HIV-HCV co-infections and aging, will be easier with antiretroviral drugs without drug-drug interactions and with a better toxicity and tolerability profile. Future assessment of economic impact for the introduction of new innovative drugs in the field of antiretroviral therapy will likely need some degree of adjustment of the evaluation criteria of costs and benefit which are currently based almost exclusively on morbidity and mortality.
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Affiliation(s)
- Massimo Andreoni
- Department of Infectious Diseases, University of Rome Tor Vergata, Rome, Italy
| | | | - Vincenzo Puro
- National Institute for Infectious Diseases "L. Spallanzani" - IRCCS, AIDS Reference Centre and Emerging Infections Unit, Rome, Italy
| | - Gabriella De Carli
- National Institute for Infectious Diseases "L. Spallanzani" - IRCCS, AIDS Reference Centre and Emerging Infections Unit, Rome, Italy
| | - Giuseppe Tambussi
- Department of Infectious and Tropical Diseases, San Raffaele Hospital IRCSS, Milan, Italy
| | - Silvia Nozza
- Department of Infectious and Tropical Diseases, San Raffaele Hospital IRCSS, Milan, Italy
| | - Andrea Gori
- Division of Infectious Diseases, Department of Internal Medicine, "San Gerardo" Hospital, University of Milan-Bicocca, Monza, Italy
| | | | - Maria Mercedes Santoro
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Clementi
- Laboratory of Microbiology, San Raffaele Hospital IRCSS, Milan, Italy
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Franco Maggiolo
- Division of Infectious Diseases, AO Papa Giovanni XXIII, Bergamo, Italy
| | - Antonella Castagna
- Department of Infectious and Tropical Diseases, San Raffaele Hospital IRCSS, Milan, Italy
| | - Andrea De Luca
- Department of Internal and Specialty Medicine, University Infectious Diseases Unit, AOU Senese, Siena, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Science, University of Milan, Italy
| | | | - Marco Borderi
- Department of Medical and Surgical Sciences, Infectious Disease Unit, Alma Mater Studiorum, University of Bologna, Italy
| | | | - Andrea Calcagno
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Italy
| | - Giovanni Di Perri
- Laboratory of Virology, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Stefano Bonora
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Italy
| | - Cristina Mussini
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Antonio Di Biagio
- Infectious Disease Clinic, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Genova, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Raffaele Bruno
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Zuccaro
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Paola Cinque
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Croce
- CREMS (Centre for Research on Health Economics, Social and Health Care Management, Carlo Cattaneo - LIUC University, Castellanza (VA), Italy
- Italian School of Public Health, Faculty of health science
| | - Umberto Restelli
- CREMS (Centre for Research on Health Economics, Social and Health Care Management, Carlo Cattaneo - LIUC University, Castellanza (VA), Italy
- Italian School of Public Health, Faculty of health science
| | | | - Adriano Lazzarin
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
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Kato M, Long NH, Duong BD, Nhan DT, Nguyen TTV, Hai NH, Giang LM, Hoa DM, Van NT, Suthar AB, Fontaine C, Nadol P, Lo YR, McConnell MS. Enhancing the benefits of antiretroviral therapy in Vietnam: towards ending AIDS. Curr HIV/AIDS Rep 2015; 11:487-95. [PMID: 25472886 PMCID: PMC4264957 DOI: 10.1007/s11904-014-0235-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Vietnam has a concentrated HIV epidemic, with the highest HIV prevalence being observed among people who inject drugs (PWID). Based on its experience scaling-up robust HIV interventions, Vietnam aims to further strengthen its response by harnessing the preventive benefits of antiretroviral therapy (ART). Mathematical modelling suggests that prioritizing key populations for earlier access to ART, combined with other prevention interventions, may have significant impact on the epidemic, cost-effectively reducing new HIV infections and deaths. Pilot studies are being conducted to assess feasibility and acceptability of expansion of HIV testing and counselling (HTC) and early ART among key populations and to demonstrate innovative service delivery models to address challenges in uptake of services across the care cascade. Earlier access of key populations to combination prevention interventions, combined with sustained political commitment and supportive environment for key populations, are essential for maximum impact of ART on the HIV epidemic in Vietnam.
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Affiliation(s)
- Masaya Kato
- World Health Organization Vietnam Country Office, 6 3 Tran Hung Dao Street, Hanoi, Vietnam,
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Zhang X, Li M, Feng Y, Bu K, Fu G, Liu X, Chen Y, Shi L, Bai C, Wei H, Huan X, Wang L. [Study on economic burden caused by antiretroviral treatment for people living with HIV/AIDS and influencing factors in Nanjing]. Zhonghua Liu Xing Bing Xue Za Zhi 2015; 36:440-444. [PMID: 26080630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To understand the economic burden caused by antiretroviral treatment for people living with HIV/AIDS and influencing factors in Nanjing. METHODS People living with HIV/AIDS were divided into two groups, HIV infected patients and AIDS patients. The data about their direct medical expenditure, direct non-medical expenditure and indirect economic loss in the past year were collected. Univariate and multivariate analysis were conducted to identify the potential influencing factors. RESULTS The median of direct medical expenditure and total costs for 133 HIV infected patients were 1,200 yuan RMB and 1,972 yuan RMB respectively. The median of direct medical expenditure and total costs for 145 AIDS patients were 1 060 yuan RMB and 2 826 yuan RMB respectively. The differences in direct medical expenditure and total costs between HIV infected patients and AIDS patients showed no statistical significance. The results from univariate analysis indicated that the sample source influenced total costs significantly. Multivariate analysis showed that onset time and CD level were negatively correlated with direct medical expenditure. The patients infected through heterosexual contact had more direct medical expenditure than those infected through homosexual contact. The patients receiving HIV test in hospitals had more direct medical expenditure than those receiving volunteer counseling and testing. CONCLUSION Further efforts should be made to expand HIV testing and treatment coverage in order to detect HIV infections as early as possible. Early antiretroviral treatment should be given to HIV infected patients to maintain their immunity and reduce their medical expenditure.
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Affiliation(s)
- Xiayan Zhang
- National Center for ADIS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Meng Li
- National Center for ADIS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Yibing Feng
- National Center for ADIS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Kai Bu
- National Center for ADIS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention
| | - Xiaoyan Liu
- Jiangsu Provincial Center for Disease Control and Prevention
| | - Yuheng Chen
- Jiangsu Provincial Center for Disease Control and Prevention
| | - Lingen Shi
- Jiangsu Provincial Center for Disease Control and Prevention
| | | | | | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention;
| | - Lu Wang
- National Center for ADIS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China;
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Tsuyuki K, Surratt HL, Levi-Minzi MA, O'Grady CL, Kurtz SP. The Demand for Antiretroviral Drugs in the Illicit Marketplace: Implications for HIV Disease Management Among Vulnerable Populations. AIDS Behav 2015; 19:857-68. [PMID: 25092512 PMCID: PMC4318775 DOI: 10.1007/s10461-014-0856-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The diversion of antiretroviral medications (ARVs) has implications for the integrity and success of HIV care, however little is known about the ARV illicit market. This paper aimed to identify the motivations for buying illicit ARVs and to describe market dynamics. Semi-structured interviews (n = 44) were conducted with substance-involved individuals living with HIV who have a history of purchasing ARVs on the street. Grounded theory was used to code and analyze interviews. Motivations for buying ARVs on the illicit market were: to repurchase ARVs after having diverted them for money or drugs; having limited access or low quality health care; to replace lost or ruined ARVs; and to buy a back-up stock of ARVs. This study identified various structural barriers to HIV treatment and ARV adherence that incentivized ARV diversion. Findings highlight the need to improve patient-provider relationships, ensure continuity of care, and integrate services to engage and retain high-needs populations.
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Affiliation(s)
- Kiyomi Tsuyuki
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 2 NE 40th Street, Suite 404, Miami, FL, 33137, USA,
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Schackman BR, Fleishman JA, Su AE, Berkowitz BK, Moore RD, Walensky RP, Becker JE, Voss C, Paltiel AD, Weinstein MC, Freedberg KA, Gebo KA, Losina E. The lifetime medical cost savings from preventing HIV in the United States. Med Care 2015; 53:293-301. [PMID: 25710311 PMCID: PMC4359630 DOI: 10.1097/mlr.0000000000000308] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Enhanced HIV prevention interventions, such as preexposure prophylaxis for high-risk individuals, require substantial investments. We sought to estimate the medical cost saved by averting 1 HIV infection in the United States. METHODS We estimated lifetime medical costs in persons with and without HIV to determine the cost saved by preventing 1 HIV infection. We used a computer simulation model of HIV disease and treatment (CEPAC) to project CD4 cell count, antiretroviral treatment status, and mortality after HIV infection. Annual medical cost estimates for HIV-infected persons, adjusted for age, sex, race/ethnicity, and transmission risk group, were from the HIV Research Network (range, $1854-$4545/mo) and for HIV-uninfected persons were from the Medical Expenditure Panel Survey (range, $73-$628/mo). Results are reported as lifetime medical costs from the US health system perspective discounted at 3% (2012 USD). RESULTS The estimated discounted lifetime cost for persons who become HIV infected at age 35 is $326,500 (60% for antiretroviral medications, 15% for other medications, 25% nondrug costs). For individuals who remain uninfected but at high risk for infection, the discounted lifetime cost estimate is $96,700. The medical cost saved by avoiding 1 HIV infection is $229,800. The cost saved would reach $338,400 if all HIV-infected individuals presented early and remained in care. Cost savings are higher taking into account secondary infections avoided and lower if HIV infections are temporarily delayed rather than permanently avoided. CONCLUSIONS The economic value of HIV prevention in the United States is substantial given the high cost of HIV disease treatment.
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Affiliation(s)
- Bruce R Schackman
- *Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY †Agency for Healthcare Research and Quality, Rockville, MD ‡Division of General Internal Medicine §Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA ∥Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD ¶Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA #Center for AIDS Research, Harvard University, Cambridge, MA **Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA ††Department of Health Policy and Management, Yale School of Public Health, New Haven, CT ‡‡Department of Health Policy and Management, Harvard School of Public Health, Boston, MA §§Department of Epidemiology, Boston University School of Public Health, Boston, MA ∥∥Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA ¶¶Department of Biostatistics, Boston University School of Public Health, Boston, MA
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Corbelli J. US healthcare: how losing your job can kill you in the world's richest country. BMJ 2015; 350:h1517. [PMID: 25795063 DOI: 10.1136/bmj.h1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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VanDeusen A, Paintsil E, Agyarko-Poku T, Long EF. Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana. BMC Infect Dis 2015; 15:130. [PMID: 25887574 PMCID: PMC4374181 DOI: 10.1186/s12879-015-0859-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving the goal of eliminating mother-to-child HIV transmission (MTCT) necessitates increased access to antiretroviral therapy (ART) for HIV-infected pregnant women. Option B provides ART through pregnancy and breastfeeding, whereas Option B+ recommends continuous ART regardless of CD4 count, thus potentially reducing MTCT during future pregnancies. Our objective was to compare maternal and pediatric health outcomes and cost-effectiveness of Option B+ versus Option B in Ghana. METHODS A decision-analytic model was developed to simulate HIV progression in mothers and transmission (in utero, during birth, or through breastfeeding) to current and all future children. Clinical parameters, including antenatal care access and fertility rates, were estimated from a retrospective review of 817 medical records at two hospitals in Ghana. Additional parameters were obtained from published literature. Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios. RESULTS HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3). Projected maternal life expectancy under Option B+ is 16.1 years, versus 16.0 years with Option B, yielding a gain of 0.1 maternal QALYs and 3.2 additional QALYs per child. Despite higher initial ART costs, Option B+ costs $785/QALY gained, a value considered very cost-effective by World Health Organization benchmarks. Widespread implementation of Option B+ in Ghana could theoretically prevent up to 668 HIV infections among children annually. Cost-effectiveness estimates remained favorable over robust sensitivity analyses. CONCLUSIONS Although more expensive than Option B, Option B+ substantially reduces MTCT in future pregnancies, increases both maternal and pediatric QALYs, and is a cost-effective use of limited resources in Ghana.
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Affiliation(s)
- Adam VanDeusen
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
| | - Elijah Paintsil
- Departments of Pediatrics & Pharmacology, Yale School of Medicine, Yale Child Health Research Center, 464 Congress Ave, New Haven, CT, USA.
| | - Thomas Agyarko-Poku
- Department of Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Elisa F Long
- University of California Los Angeles, Anderson School of Management, Los Angeles, CA, USA.
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Pruitt Z, Robst J, Langland-Orban B, Brooks RG. Healthcare costs associated with antiretroviral adherence among medicaid patients. Appl Health Econ Health Policy 2015; 13:69-80. [PMID: 25403718 DOI: 10.1007/s40258-014-0138-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The relationship of antiretroviral therapy (ART) adherence to total healthcare expenditures for Medicaid-insured people living with HIV or AIDS (PLWHA) is not well understood, especially among asymptomatic HIV-positive patients. OBJECTIVE This study examined Medicaid-insured HIV-positive and AIDS-diagnosed patient groups to determine the association of ART adherence to mean monthly total healthcare expenditures in the 24-month measurement period, controlling for demographic, geographic, insurance, and clinical factors. The present study extends the existing literature by analyzing the relationship of ART adherence to total healthcare costs for asymptomatic HIV-positive patients separately from those patients with AIDS-defining conditions. METHODS This retrospective study utilized claims data from Florida Medicaid claims from July 2006 through June 2011. All patients (n = 502) were HIV-positive, aged 18-64 years, non-pregnant, and ART naïve for at least 12 months prior to the measurement period. Each patient was categorized, based on medication possession ratios, as adherent (≥90 %) or non-adherent (<90 %), and were divided into two groups: HIV positive (n = 232) and AIDS diagnosed (n = 270). Generalized linear models predicted the mean monthly total expenditures for the non-adherence group versus the adherence group. RESULTS For the HIV-positive group, the adjusted mean monthly expenditures for the non-adherent group were US$1,291; the adherent group adjusted mean monthly expenditures were US$1,926. The HIV-positive non-adherent group adjusted mean monthly expenditures were significantly less than the adherent group (-40 %, p < 0.001). However, for the AIDS-diagnosed group, there was not a statistically significant association of ART adherence to total healthcare expenditures (p = 0.29). CONCLUSION The results show that the relationship of ART adherence to healthcare costs is more complex than previously reported.
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Affiliation(s)
- Zachary Pruitt
- College of Public Health, Health Policy and Management, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612-3805, USA,
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