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Mobile HIV Screening in Cape Town, South Africa: Clinical Impact, Cost and Cost-Effectiveness

Author

Listed:
  • Ingrid V Bassett
  • Darshini Govindasamy
  • Alison S Erlwanger
  • Emily P Hyle
  • Katharina Kranzer
  • Nienke van Schaik
  • Farzad Noubary
  • A David Paltiel
  • Robin Wood
  • Rochelle P Walensky
  • Elena Losina
  • Linda-Gail Bekker
  • Kenneth A Freedberg

Abstract

Background: Mobile HIV screening may facilitate early HIV diagnosis. Our objective was to examine the cost-effectiveness of adding a mobile screening unit to current medical facility-based HIV testing in Cape Town, South Africa. Methods and Findings: We used the Cost Effectiveness of Preventing AIDS Complications International (CEPAC-I) computer simulation model to evaluate two HIV screening strategies in Cape Town: 1) medical facility-based testing (the current standard of care) and 2) addition of a mobile HIV-testing unit intervention in the same community. Baseline input parameters were derived from a Cape Town-based mobile unit that tested 18,870 individuals over 2 years: prevalence of previously undiagnosed HIV (6.6%), mean CD4 count at diagnosis (males 423/µL, females 516/µL), CD4 count-dependent linkage to care rates (males 31%–58%, females 49%–58%), mobile unit intervention cost (includes acquisition, operation and HIV test costs, $29.30 per negative result and $31.30 per positive result). We conducted extensive sensitivity analyses to evaluate input uncertainty. Model outcomes included site of HIV diagnosis, life expectancy, medical costs, and the incremental cost-effectiveness ratio (ICER) of the intervention compared to medical facility-based testing. We considered the intervention to be “very cost-effective” when the ICER was less than South Africa's annual per capita Gross Domestic Product (GDP) ($8,200 in 2012). We projected that, with medical facility-based testing, the discounted (undiscounted) HIV-infected population life expectancy was 132.2 (197.7) months; this increased to 140.7 (211.7) months with the addition of the mobile unit. The ICER for the mobile unit was $2,400/year of life saved (YLS). Results were most sensitive to the previously undiagnosed HIV prevalence, linkage to care rates, and frequency of HIV testing at medical facilities. Conclusion: The addition of mobile HIV screening to current testing programs can improve survival and be very cost-effective in South Africa and other resource-limited settings, and should be a priority.

Suggested Citation

  • Ingrid V Bassett & Darshini Govindasamy & Alison S Erlwanger & Emily P Hyle & Katharina Kranzer & Nienke van Schaik & Farzad Noubary & A David Paltiel & Robin Wood & Rochelle P Walensky & Elena Losina, 2014. "Mobile HIV Screening in Cape Town, South Africa: Clinical Impact, Cost and Cost-Effectiveness," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-11, January.
    • Handle: RePEc:plo:pone00:0085197
    DOI: 10.1371/journal.pone.0085197
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    References listed on IDEAS

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    1. Tonderai Mabuto & Mary H Latka & Bulelani Kuwane & Gavin J Churchyard & Salome Charalambous & Christopher J Hoffmann, 2014. "Four Models of HIV Counseling and Testing: Utilization and Test Results in South Africa," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-7, July.
    2. Gregg S. Gonsalves & Forrest W. Crawford & Paul D. Cleary & Edward H. Kaplan & A. David Paltiel, 2018. "An Adaptive Approach to Locating Mobile HIV Testing Services," Medical Decision Making, , vol. 38(2), pages 262-272, February.

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