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Clinical Impact and Cost-Effectiveness of Expanded Voluntary HIV Testing in India

Author

Listed:
  • Kartik K Venkatesh
  • Jessica E Becker
  • Nagalingeswaran Kumarasamy
  • Yoriko M Nakamura
  • Kenneth H Mayer
  • Elena Losina
  • Soumya Swaminathan
  • Timothy P Flanigan
  • Rochelle P Walensky
  • Kenneth A Freedberg

Abstract

Background: Despite expanding access to antiretroviral therapy (ART), most of the estimated 2.3 to 2.5 million HIV-infected individuals in India remain undiagnosed. The questions of whom to test for HIV and at what frequency remain unclear. Methods: We used a simulation model of HIV testing and treatment to examine alternative HIV screening strategies: 1) current practice, 2) one-time, 3) every five years, and 4) annually; and we applied these strategies to three population scenarios: 1) the general Indian population (“national population”), i.e. base case (HIV prevalence 0.29%; incidence 0.032/100 person-years [PY]); 2) high-prevalence districts (HIV prevalence 0.8%; incidence 0.088/100 PY), and 3) high-risk groups (HIV prevalence 5.0%; incidence 0.552/100 PY). Cohort characteristics reflected Indians reporting for HIV testing, with a median age of 35 years, 66% men, and a mean CD4 count of 305 cells/µl. The cost of a rapid HIV test was $3.33. Outcomes included life expectancy, HIV-related direct medical costs, incremental cost-effectiveness ratios (ICERs), and secondary transmission benefits. The threshold for “cost-effective” was defined as 3x the annual per capita GDP of India ($3,900/year of life saved [YLS]), or for “very cost-effective” was

Suggested Citation

  • Kartik K Venkatesh & Jessica E Becker & Nagalingeswaran Kumarasamy & Yoriko M Nakamura & Kenneth H Mayer & Elena Losina & Soumya Swaminathan & Timothy P Flanigan & Rochelle P Walensky & Kenneth A Free, 2013. "Clinical Impact and Cost-Effectiveness of Expanded Voluntary HIV Testing in India," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-11, May.
    • Handle: RePEc:plo:pone00:0064604
    DOI: 10.1371/journal.pone.0064604
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    References listed on IDEAS

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    1. Yazdan Yazdanpanah & Caroline E Sloan & Cécile Charlois-Ou & Stéphane Le Vu & Caroline Semaille & Dominique Costagliola & Josiane Pillonel & Anne-Isabelle Poullié & Olivier Scemama & Sylvie Deuffic-Bu, 2010. "Routine HIV Screening in France: Clinical Impact and Cost-Effectiveness," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-9, October.
    2. Y. Yazdanpanah & E. Losina & X. Anglaret & S.J. Goldie & R.P. Walensky & M.C. Weinstein & S. Toure & H.E. Smith & J.E. Kaplan & K.A. Freedberg & For The Global Aids Policy Model Investigators, 2005. "Clinical impact and cost-effectiveness of co-trimoxazole prophylaxis in patients with HIV/AIDS in Cote d'Ivoire: a trial-based analysis," Post-Print hal-00201936, HAL.
    3. Lauren M Uhler & Nagalingeswaran Kumarasamy & Kenneth H Mayer & Anjali Saxena & Elena Losina & Malaisamy Muniyandi & Adam W Stoler & Zhigang Lu & Rochelle P Walensky & Timothy P Flanigan & Melissa A B, 2010. "Cost-Effectiveness of HIV Testing Referral Strategies among Tuberculosis Patients in India," PLOS ONE, Public Library of Science, vol. 5(9), pages 1-9, September.
    4. S.J. Goldie & Y. Yazdanpanah & E. Losina & M.C. Weinstein & X. Anglaret & R.P. Walensky & H.E. Hsu & A. Kimmel & C. Holmes & J.E. Kaplan & K.A. Freedberg, 2006. "Cost-effectiveness of HIV treatment in Resource-Poor Settings - The case of Côte d'Ivoire," Post-Print hal-00199992, HAL.
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    1. Eric N Ouattara & Rachel L MacLean & Christine Danel & Ethan D Borre & Delphine Gabillard & Mingshu Huang & Raoul Moh & A David Paltiel & Serge P Eholié & Rochelle P Walensky & Xavier Anglaret & Kenne, 2019. "Cost-effectiveness and budget impact of immediate antiretroviral therapy initiation for treatment of HIV infection in Côte d’Ivoire: A model-based analysis," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-16, June.

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