Comparative cost analysis of point-of-care versus laboratory-based testing to initiate and monitor HIV treatment in South Africa

Simeon, Kate; Sharma, Monisha; Dorward, Jienchi; Naidoo, Jessica; Dlamini, N; Moodley, Prashini; Samsunder, Natasha; Barnabas, Ruanne V.; Garrett, Nigel; Drain, Paul K.

doi:10.1371/journal.pone.0223669

Cited by 33 publications

(29 citation statements)

References 23 publications

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“…Our findings are similar to previous costing studies, which estimated the cost per POC VL test to be between $25 and $30 [ 8 , 13 ]. One study in South Africa found that staff time to collect a sample and conduct the POC VL test contributed $8 to the per-test cost, which is substantially higher than our staff costs [ 23 ].…”

Section: Discussionsupporting

confidence: 91%

“…In Kenya, children with HIV are more likely to have elevated viral loads than adults [ 12 ]. Implementing nation-wide POC VL testing platforms to complement existing centralized laboratory testing can alleviate the burden on centralized laboratories and reduce delays by enabling the rapid return of VL results and counseling within the same clinical visit [ 13 ]. The cost of implementing POC VL testing in Kenya is uncertain.…”

Section: Introductionmentioning

confidence: 99%

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Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya

et al. 2021

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Background: The number of people living with HIV (PLHIV) in need of treatment monitoring in low-and-middle-income countries is rapidly expanding, straining existing laboratory capacity. Point-of-care viral load (POC VL) testing can alleviate the burden on centralized laboratories and enable faster delivery of results, improving clinical outcomes. However, implementation costs are uncertain and will depend on clinic testing volume. We sought to estimate the costs of decentralized POC VL testing compared to centralized laboratory testing for adults and children receiving HIV care in Kenya. Methods: We conducted microcosting to estimate the per-patient costs of POC VL testing compared to known costs of centralized laboratory testing. We completed time-and-motion observations and stakeholder interviews to assess personnel structures, staff time, equipment costs, and laboratory processes associated with POC VL administration. Capital costs were estimated using a 5 year lifespan and a 3% annual discount rate. Results: We estimated that POC VL testing cost USD $24.25 per test, assuming a clinic is conducting 100 VL tests per month. Test cartridge and laboratory equipment costs accounted for most of the cost (62% and 28%, respectively). Costs varied by number of VL tests conducted at the clinic, ranging from $54.93 to $18.12 per test assuming 20 to 500 VL tests per month, respectively. A VL test processed at a centralized laboratory was estimated to cost USD $25.65. Conclusion: POC VL testing for HIV treatment monitoring can be feasibly implemented in clinics within Kenya and costs declined with higher testing volumes. Our cost estimates are useful to policymakers in planning resource allocation and can inform cost-effectiveness analyses evaluating POC VL testing.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya

et al. 2021

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“…In Kenya, 51% of healthcare expenses are payed out of pocket, healthcare costs are often covered through “harambees“ fundraising events in the community; 46% of the population only has USD 1 or less to spend each day [ 28 ]. HCTs platforms have high fixed costs for the PoC device itself and, therefore, the cost per test is strongly dependent on the use case and the workload of the device to be economically justifiable [ 71 ]; therefore, those diagnostic devices, with their high implementation cost, are considered as too expensive for widespread use [ 70 ]. A good example for this is HIV diagnosis and monitoring.…”

Section: The Marketmentioning

confidence: 99%

“…However, assuming only 10 patients per month, this would increase to a USD 183 additional cost over the same timeframe. Price is also dependent on which biomarker is analyzed, as viral load was, in the 50 patients per month case, just as cost effective as in the laboratory, while CD4+ count and creatinine test were more expensive [ 71 ]. The notion of cost effective PoC ART monitoring is supported by several mathematical simulations from South Africa, Zimbabwe and Mozambique, especially when all the costs are taken into account.…”

Section: The Marketmentioning

confidence: 99%

Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment

et al. 2020

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Point of care (PoC) diagnostics are at the focus of government initiatives, NGOs and fundamental research alike. In high-income countries, the hope is to streamline the diagnostic procedure, minimize costs and make healthcare processes more efficient and faster, which, in some cases, can be more a matter of convenience than necessity. However, in resource-limited settings such as low-income countries, PoC-diagnostics might be the only viable route, when the next laboratory is hours away. Therefore, it is especially important to focus research into novel diagnostics for these countries in order to alleviate suffering due to infectious disease. In this review, the current research describing the use of PoC diagnostics in resource-limited settings and the potential bottlenecks along the value chain that prevent their widespread application is summarized. To this end, we will look at literature that investigates different parts of the value chain, such as fundamental research and market economics, as well as actual use at healthcare providers. We aim to create an integrated picture of potential PoC barriers, from the first start of research at universities to patient treatment in the field. Results from the literature will be discussed with the aim to bring all important steps and aspects together in order to illustrate how effectively PoC is being used in low-income countries. In addition, we discuss what is needed to improve the situation further, in order to use this technology to its fullest advantage and avoid “leaks in the pipeline”, when a promising device fails to take the next step of the valorization pathway and is abandoned.

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“…Still further research seems beneficial on the cost-effectiveness analysis of routine HIV screening in dental setting. There are only a small number of published articles [34][35][36][37][38][39][40] on the cost-effectiveness of HIV screening in primary care setting. Our findings corroborate one of their suggestions: Routine HIV screening is more cost-effective in high-prevalence regions.…”

Section: Plos Onementioning

confidence: 99%

HIV screening in the dental setting in New York State

et al. 2020

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While primary care providers in New York State (NYS) are mandated to offer all patients a HIV test, still many NYS residents miss the HIV screening opportunity. To fill the gap, and as the CDC recommends, this study aimed to examine the feasibility of implementing HIV screening in dental setting, identify patient characteristics associated with acceptance of HIV rapid testing, and discuss best practices of HIV screening in dental setting. New York State Department of Health (NYSDOH) collaborated with the Northeast/Caribbean AIDS Education and Training Center (NECA AETC) and three dental schools in New York State to offer free HIV screening tests as a component of routine dental care between February 2016 and March 2018. Ten clinics in upstate New York and Long Island participated in the study. HIV screening was performed using the OraQuick™ In-Home HIV Test. 14,887 dental patients were offered HIV screening tests; 9,057 (60.8%) were screened; and one patient (0.011%) was confirmed HIV positive and linked to medical care. Of all dental patients, 33% had never been screened for HIV; and 56% had not had a primary care visit or had not been offered an HIV screening test by primary care providers in the previous 12 months. Multilevel generalized linear modeling analysis indicated that test acceptance was significantly associated with patient's age, race/ethnicity, gender, country of origin, primary payer (or insurance), past primary care visits, past HIV testing experiences, and the poverty level of patient's community. HIV screening is well accepted by dental patients and can be effectively integrated into routine dental care. HIV screening in the dental setting can be a good option for first-time testers, those who have not seen a primary care provider in the last 12 months, and those who have not been offered HIV screening at their last primary care visit.

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Comparative cost analysis of point-of-care versus laboratory-based testing to initiate and monitor HIV treatment in South Africa

Cited by 33 publications

References 23 publications

Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya

Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya

Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment

HIV screening in the dental setting in New York State

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