HIV Treatment as Prevention: Issues in Economic Evaluation
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TLDR
Economic evaluations of antiretroviral therapy in currently existing programs and in HIV treatment as prevention (TasP) programs should use cost functions that capture cost dependence on a number of factors, such as scale and scope of delivery.Abstract:
Meyer-Rath and Over assert in another article in the July 2012 PLoS Medicine Collection, “Investigating the Impact of Treatment on New HIV Infections”, that economic evaluations of antiretroviral therapy (ART) in currently existing programs and in HIV treatment as prevention (TasP) programs should use cost functions that capture cost dependence on a number of factors, such as scale and scope of delivery, health states, ART regimens, health workers' experience, patients' time on treatment, and the distribution of delivery across public and private sectors. We argue that for particular evaluation purposes (e.g., to establish the social value of TasP) and from particular perspectives (e.g., national health policy makers) less detailed cost functions may be sufficient. We then extend the discussion of economic evaluation of TasP, describing why ART outcomes and costs assessed in currently existing programs are unlikely to be generalizable to TasP programs for several fundamental reasons. First, to achieve frequent, widespread HIV testing and high uptake of ART immediately following an HIV diagnosis, TasP programs will require components that are not present in current ART programs and whose costs are not included in current estimates. Second, the early initiation of ART under TasP will change not only patients' disease courses and treatment experiences—which can affect behaviors that determine clinical treatment success, such as ART adherence and retention—but also quality of life and economic outcomes for HIV-infected individuals. Third, the preventive effects of TasP are likely to alter the composition of the HIV-infected population over time, changing its biological and behavioral characteristics and leading to different costs and outcomes for ART.read more
Citations
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Journal ArticleDOI
Addressing social issues in a universal HIV test and treat intervention trial (ANRS 12249 TasP) in South Africa: methods for appraisal.
Joanna Orne-Gliemann,Joseph Larmarange,Joseph Larmarange,Sylvie Boyer,Collins Iwuji,Nuala McGrath,Nuala McGrath,Till Bärnighausen,Till Bärnighausen,Thembelile Zuma,Rosemary Dray-Spira,Rosemary Dray-Spira,Bruno Spire,Tamsen J. Rochat,John Imrie,John Imrie +15 more
TL;DR: A multidisciplinary, multi-level, mixed-method research protocol that includes individual, household, community and clinic surveys, and combines quantitative and qualitative methods is described that is nested within the ANRS 12249 Treatment-as-Prevention (TasP) cluster-randomised trial in rural South Africa.
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Human resources needs for universal access to antiretroviral therapy in South Africa: a time and motion study
Jan A. C. Hontelez,Marie-Louise Newell,Ruth M Bland,Ruth M Bland,Kristen Munnelly,Richard J Lessells,Richard J Lessells,Till Bärnighausen,Till Bärnighausen +8 more
TL;DR: Universal access to HIV treatment for patients with a CD4 cell count of ≤350 cells/μl in South Africa may be affordable, but the number of HHWs available for HIV treatment will need to be substantially increased.
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Examining the evidence on the causal effect of HAART on transmission of HIV using the Bradford Hill criteria.
Bohdan Nosyk,Bertrand Audoin,Chris Beyrer,Pedro Cahn,Reuben Granich,Diane V. Havlir,Elly Katabira,Joep M. A. Lange,Viviane D. Lima,Thomas L. Patterson,Steffanie A. Strathdee,Brian G. Williams,Julio S. G. Montaner +12 more
TL;DR: It is concluded that the opportunity cost of inaction while waiting for additional evidence on the generalizability of effect in other risk groups is too high and efforts should be redoubled to mobilize the financial capital and political will to optimize implementation of HIV Treatment as Prevention strategies on a wide scale.
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Optimal Treatment Strategies in the Context of ‘Treatment for Prevention’ against HIV-1 in Resource-Poor Settings
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Antiretroviral Therapy and Nutrition in Southern Africa: Citizenship and the Grammar of Hunger.
TL;DR: Taking the gut as a particular kind of mediator of experience, ethnographic fieldwork conducted in KwaZulu-Natal, South Africa is drawn to open up a set of questions on acknowledgment and avoidance about the relationship between hunger and ART.
References
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Prevention of HIV-1 Infection with Early Antiretroviral Therapy
Myron S. Cohen,Ying Q. Chen,Marybeth McCauley,Theresa Gamble,Mina C. Hosseinipour,Nagalingeswaran Kumarasamy,James Hakim,Johnstone Kumwenda,Beatriz Grinsztejn,José Henrique Pilotto,Sheela Godbole,Sanjay Mehendale,Suwat Chariyalertsak,Breno Santos,Kenneth H. Mayer,Irving F. Hoffman,Susan H. Eshleman,Estelle Piwowar-Manning,Lei Wang,Joseph Makhema,Lisa A. Mills,Guy de Bruyn,Ian Sanne,Joseph J. Eron,Joel E. Gallant,Diane V. Havlir,Susan Swindells,Heather J. Ribaudo,Vanessa Elharrar,David N. Burns,Taha E. Taha,Karin Nielsen-Saines,David D. Celentano,Myron Essex,Thomas R. Fleming +34 more
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TL;DR: These Guidelines were developed by the Panel* on Clinical Practices for Treatment of HIV Infection convened by the Department of Health and Human Services and the Henry J. Kaiser Family Foundation.
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Prevention of HIV-1 infection with early antiretroviral therapy
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Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model
TL;DR: A theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics.
Journal ArticleDOI
HIV treatment as prevention: Systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa
Jeffrey W. Eaton,Leigh F. Johnson,Joshua A. Salomon,Till Bärnighausen,Till Bärnighausen,Eran Bendavid,Anna Bershteyn,David E. Bloom,Valentina Cambiano,Christophe Fraser,Jan A. C. Hontelez,Salal Humair,Salal Humair,Daniel J. Klein,Elisa F Long,Andrew N. Phillips,Carel Pretorius,John Stover,Edward Allen Wenger,Brian G. Williams,Timothy B. Hallett +20 more
TL;DR: In this article, the authors compared the predictions of several mathematical models simulating the same ART intervention programmes to determine the extent to which models agree about the epidemiological impact of expanded ART.
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