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The potential impact of expanding antiretroviral therapy and combination prevention in Vietnam: towards elimination of HIV transmission.

Kato M, Granich R, Bui DD, Tran HV, Nadol P, Jacka D, Sabin K, Suthar AB, Mesquita F, Lo YR, Williams B - J. Acquir. Immune Defic. Syndr. (2013)

Bottom Line: Annual HTC and immediate treatment for key populations, combined with scale-up of methadone maintenance therapy and condom use, will reduce new infections by 14,723 (81%) with similar costs (US $22.7 million).This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years and will result in a relative cost saving after 19 years.Targeted periodic HTC and immediate ART combined with other interventions is cost-effective and could lead to potential elimination of HIV in Can Tho.

View Article: PubMed Central - PubMed

Affiliation: *World Health Organization Vietnam Country Office, Hanoi, Vietnam; †World Health Organization HIV/AIDS Department, Geneva, Switzerland; ‡Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam; §Partners in Health Research, Hanoi, Vietnam; ‖US Center for Disease Prevention and Control Vietnam Country Office, Hanoi, Vietnam; ¶World Health Organization Regional Office for the Western Pacific Manila, Philippines; and #South African Centre for Epidemiological Modelling and Analysis, Geneva, Switzerland.

ABSTRACT

Background: Few studies have assessed the effects of antiretroviral therapy (ART) to prevent HIV transmission in Asian HIV epidemics. Vietnam has a concentrated HIV epidemic with the highest prevalence among people who inject drugs. We investigated the impact of expanded HIV testing and counseling (HTC) and early ART, combined with other prevention interventions on HIV transmission.

Methods: A deterministic mathematical model was developed using HIV prevalence trends in Can Tho province, Vietnam. Scenarios included offering periodic HTC and immediate ART with and without targeting subpopulations and examining combined strategies with methadone maintenance therapy and condom use.

Results: From 2011 to 2050, maintaining current interventions will incur an estimated 18,115 new HIV infections and will cost US $22.1 million (reference scenario). Annual HTC and immediate treatment, if offered to all adults, will reduce new HIV infections by 14,513 (80%) and will cost US $76.9 million. Annual HTC and immediate treatment offered only to people who inject drugs will reduce new infections by 13,578 (75%) and will cost only US $23.6 million. Annual HTC and immediate treatment for key populations, combined with scale-up of methadone maintenance therapy and condom use, will reduce new infections by 14,723 (81%) with similar costs (US $22.7 million). This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years and will result in a relative cost saving after 19 years.

Conclusions: Targeted periodic HTC and immediate ART combined with other interventions is cost-effective and could lead to potential elimination of HIV in Can Tho.

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Related in: MedlinePlus

Cumulative DALY saved and cost of HTC and ART from 2011 to 2050 of 13 analyzed scenarios. Brown box refers to universal PTIT scenarios with varying HTC interval (2 year, 1 year, and 6 months). Blue diamond refers to targeted PTIT scenarios with annual HTC focusing on single subpopulations (PWID, FSW, MSM, MCF, and LRW). SA, standard ART scale-up to 90% of those with CD4 below 350 cells per cubic millimeter. Combination + ART 350, combination prevention scale-up with standard ART. Combination + PTIT, combination prevention scale-up with PTIT for PWID, FSW, and MSM.
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Figure 3: Cumulative DALY saved and cost of HTC and ART from 2011 to 2050 of 13 analyzed scenarios. Brown box refers to universal PTIT scenarios with varying HTC interval (2 year, 1 year, and 6 months). Blue diamond refers to targeted PTIT scenarios with annual HTC focusing on single subpopulations (PWID, FSW, MSM, MCF, and LRW). SA, standard ART scale-up to 90% of those with CD4 below 350 cells per cubic millimeter. Combination + ART 350, combination prevention scale-up with standard ART. Combination + PTIT, combination prevention scale-up with PTIT for PWID, FSW, and MSM.

Mentions: Figure 3 maps the scenarios against cumulative cost and DALYs averted. The reference scenario costs US $ 122 per DALY saved. There were 2 nondominated scenarios as follows: combination prevention scale-up (US $98/DALY averted) and combination prevention with PTIT for key populations (US $78/DALY averted). Incremental cost effectiveness ratio of the latter against the former is US $28 per DALY. Targeted PTIT focusing on PWID also had similar cost-effectiveness profile as the latter, and was close to “efficiency frontier” (Fig. 3). Other scenarios studied were dominated.


The potential impact of expanding antiretroviral therapy and combination prevention in Vietnam: towards elimination of HIV transmission.

Kato M, Granich R, Bui DD, Tran HV, Nadol P, Jacka D, Sabin K, Suthar AB, Mesquita F, Lo YR, Williams B - J. Acquir. Immune Defic. Syndr. (2013)

Cumulative DALY saved and cost of HTC and ART from 2011 to 2050 of 13 analyzed scenarios. Brown box refers to universal PTIT scenarios with varying HTC interval (2 year, 1 year, and 6 months). Blue diamond refers to targeted PTIT scenarios with annual HTC focusing on single subpopulations (PWID, FSW, MSM, MCF, and LRW). SA, standard ART scale-up to 90% of those with CD4 below 350 cells per cubic millimeter. Combination + ART 350, combination prevention scale-up with standard ART. Combination + PTIT, combination prevention scale-up with PTIT for PWID, FSW, and MSM.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814627&req=5

Figure 3: Cumulative DALY saved and cost of HTC and ART from 2011 to 2050 of 13 analyzed scenarios. Brown box refers to universal PTIT scenarios with varying HTC interval (2 year, 1 year, and 6 months). Blue diamond refers to targeted PTIT scenarios with annual HTC focusing on single subpopulations (PWID, FSW, MSM, MCF, and LRW). SA, standard ART scale-up to 90% of those with CD4 below 350 cells per cubic millimeter. Combination + ART 350, combination prevention scale-up with standard ART. Combination + PTIT, combination prevention scale-up with PTIT for PWID, FSW, and MSM.
Mentions: Figure 3 maps the scenarios against cumulative cost and DALYs averted. The reference scenario costs US $ 122 per DALY saved. There were 2 nondominated scenarios as follows: combination prevention scale-up (US $98/DALY averted) and combination prevention with PTIT for key populations (US $78/DALY averted). Incremental cost effectiveness ratio of the latter against the former is US $28 per DALY. Targeted PTIT focusing on PWID also had similar cost-effectiveness profile as the latter, and was close to “efficiency frontier” (Fig. 3). Other scenarios studied were dominated.

Bottom Line: Annual HTC and immediate treatment for key populations, combined with scale-up of methadone maintenance therapy and condom use, will reduce new infections by 14,723 (81%) with similar costs (US $22.7 million).This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years and will result in a relative cost saving after 19 years.Targeted periodic HTC and immediate ART combined with other interventions is cost-effective and could lead to potential elimination of HIV in Can Tho.

View Article: PubMed Central - PubMed

Affiliation: *World Health Organization Vietnam Country Office, Hanoi, Vietnam; †World Health Organization HIV/AIDS Department, Geneva, Switzerland; ‡Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam; §Partners in Health Research, Hanoi, Vietnam; ‖US Center for Disease Prevention and Control Vietnam Country Office, Hanoi, Vietnam; ¶World Health Organization Regional Office for the Western Pacific Manila, Philippines; and #South African Centre for Epidemiological Modelling and Analysis, Geneva, Switzerland.

ABSTRACT

Background: Few studies have assessed the effects of antiretroviral therapy (ART) to prevent HIV transmission in Asian HIV epidemics. Vietnam has a concentrated HIV epidemic with the highest prevalence among people who inject drugs. We investigated the impact of expanded HIV testing and counseling (HTC) and early ART, combined with other prevention interventions on HIV transmission.

Methods: A deterministic mathematical model was developed using HIV prevalence trends in Can Tho province, Vietnam. Scenarios included offering periodic HTC and immediate ART with and without targeting subpopulations and examining combined strategies with methadone maintenance therapy and condom use.

Results: From 2011 to 2050, maintaining current interventions will incur an estimated 18,115 new HIV infections and will cost US $22.1 million (reference scenario). Annual HTC and immediate treatment, if offered to all adults, will reduce new HIV infections by 14,513 (80%) and will cost US $76.9 million. Annual HTC and immediate treatment offered only to people who inject drugs will reduce new infections by 13,578 (75%) and will cost only US $23.6 million. Annual HTC and immediate treatment for key populations, combined with scale-up of methadone maintenance therapy and condom use, will reduce new infections by 14,723 (81%) with similar costs (US $22.7 million). This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years and will result in a relative cost saving after 19 years.

Conclusions: Targeted periodic HTC and immediate ART combined with other interventions is cost-effective and could lead to potential elimination of HIV in Can Tho.

Show MeSH
Related in: MedlinePlus