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Home >> Publications >> Point-of-Care CD4 Testing to Inform Selection of Antiretroviral Medications in South African Antenatal Clinics: A Cost-Effectiveness Analysis.

Publication

Author(s):

Ciaranello AL, Myer L, Kelly K, Christensen S, Daskilewicz K, Doherty K, Bekker LG, Hou T, Wood R, Francke JA, Wools-Kaloustian K, Freedberg KA, Walensky RP.

Pub Title:

Point-of-Care CD4 Testing to Inform Selection of Antiretroviral Medications in South African Antenatal Clinics: A Cost-Effectiveness Analysis.

Pub Date:

Mar 10 2015

Pub Region(s):

East Africa

Journal:

Title: 
PLoS One
Link: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355621/

PubMed: 25756498
Pub PDF: PDF icon 25756498.pdf

Abstract
BACKGROUND:
Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays.

METHODS: We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved).

RESULTS: In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs.

CONCLUSIONS: In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.

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Citation:

Ciaranello AL, Myer L, Kelly K, Christensen S, Daskilewicz K, Doherty K, Bekker LG, Hou T, Wood R, Francke JA, Wools-Kaloustian K, Freedberg KA, Walensky RP. Point-of-Care CD4 Testing to Inform Selection of Antiretroviral Medications in South African Antenatal Clinics: A Cost-Effectiveness Analysis. PLoS One. 2015 Mar 10;10(3):e0117751. doi: 10.1371/journal.pone.0117751. eCollection 2015. PubMed PMID: 25756498; PubMed Central PMCID: PMC4355621.