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Economic costs and health-related quality of life outcomes of HIV treatment following self- and facility-based HIV testing in a cluster randomised trial.
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Maheswaran, Hendramoorthy, Petrou, Stavros, MacPherson, P., Kumwenda, F., Lalloo, D. G., Corbett, E. L. and Clarke, Aileen (2017) Economic costs and health-related quality of life outcomes of HIV treatment following self- and facility-based HIV testing in a cluster randomised trial. Journal of Acquired Immune Deficiency Syndromes, 75 (3). pp. 280-289. doi:10.1097/QAI.0000000000001373 ISSN 1525-4135.
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Official URL: http://doi.org/10.1097/QAI.0000000000001373
Abstract
Background: The scale-up of HIV self-testing (HIVST) in Africa is recommended, but little is known about how this novel approach influences economic outcomes following subsequent antiretroviral treatment (ART) compared with established facility-based HIV testing and counseling (HTC) approaches.
Setting: HIV clinics in Blantyre, Malawi.
Methods: Consecutive HIV-positive participants, diagnosed by HIVST or facility-based HTC as part of a community cluster-randomized trial (ISRCTN02004005), were followed from initial assessment for ART until 1-year postinitiation. Healthcare resource use was prospectively measured, and primary costing studies undertaken to estimate total health provider costs. Participants were interviewed to establish direct nonmedical and indirect costs over the first year of ART. Costs were adjusted to 2014 US$ and INT$. Health-related quality of life was measured using the EuroQol EQ-5D at each clinic visit. Multivariable analyses estimated predictors of economic outcomes.
Results: Of 325 participants attending HIV clinics for assessment for ART, 265 were identified through facility-based HTC, and 60 through HIVST; 168/265 (69.2%) and 36/60 (60.0%), respectively, met national ART eligibility criteria and initiated treatment. The mean total health provider assessment costs for ART initiation were US$22.79 (SE: 0.56) and US$19.92 (SE: 0.77) for facility-based HTC and HIVST participants, respectively, and was US$2.87 (bootstrap 95% CI: US$1.01 to US$4.73) lower for the HIVST group. The mean total health provider costs for the first year of ART were US$168.65 (SE: 2.02) and US$164.66 (SE: 4.21) for facility-based HTC and HIVST participants, respectively, and comparable between the 2 groups (bootstrap 95% CI: −US$12.38 to US$4.39). EQ-5D utility scores immediately before and one year after ART initiation were comparable between the 2 groups. EQ-5D utility scores 1 year after ART initiation had increased by 0.129 (SE: 0.011) and 0.139 (SE: 0.027) for facility-based HTC and HIVST participants, respectively.
Item Type: | Journal Article | |||||||||||||||
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Subjects: | R Medicine > RC Internal medicine | |||||||||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | HIV (Viruses) -- Treatment -- Cost effectiveness -- Blantyre (Malawi) -- Case studies | |||||||||||||||
Journal or Publication Title: | Journal of Acquired Immune Deficiency Syndromes | |||||||||||||||
Publisher: | Lippincott Williams & Wilkins | |||||||||||||||
ISSN: | 1525-4135 | |||||||||||||||
Official Date: | 1 July 2017 | |||||||||||||||
Dates: |
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Volume: | 75 | |||||||||||||||
Number: | 3 | |||||||||||||||
Page Range: | pp. 280-289 | |||||||||||||||
DOI: | 10.1097/QAI.0000000000001373 | |||||||||||||||
Status: | Peer Reviewed | |||||||||||||||
Publication Status: | Published | |||||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||||||||
Date of first compliant deposit: | 1 June 2017 | |||||||||||||||
Date of first compliant Open Access: | 9 August 2017 | |||||||||||||||
Funder: | Wellcome Trust (London, England), Collaborations for Leadership in Applied Health Research and Care (CLAHRC), Medical Research Council (Great Britain) (MRC) | |||||||||||||||
Grant number: | WT097973, WT091769) (Wellcome Trust (London, England)), MR/M0501633/1 (MRC) | |||||||||||||||
RIOXX Funder/Project Grant: |
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