Cost-Effectiveness of Preventing Loss to Follow-up in HIV Treatment Programs: A Côte d'Ivoire Appraisal

Losina, Elena; Touré, Hapsatou; Uhler, Lauren M.; Anglaret, Xavier; Paltiel, A. David; Balestre, Eric; Walensky, Rochelle P.; Messou, Eugène; Weinstein, Milton C.; Dabis, François; Freedberg, Kenneth A.

doi:10.1371/journal.pmed.1000173

Cited by 70 publications

(77 citation statements)

References 46 publications

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“…Several studies have shown the cost-effectiveness of HIV linkage and retention in care programs implemented in the USA (Creese, Floyd, Alban, & Guinness, 2002;Hogan, Baltussen, Hayashi, Lauer, & Salomon, 2005;Holtgrave, 1998;Kim et al, 2015;Losina et al, 2009;Marseille et al, 2009Marseille et al, , 2012Renaud, Basenya, De Borman, Greindl, & Meyer-Rath, 2009;Walker, 2003). The evaluators of Health Resources and Services Administration's Special Projects of National Significance found program costs of $241,565 ($393 per patient) (Gopalappa, Farnham, Hutchinson, & Sansom, 2012).…”

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confidence: 99%

Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs

et al. 2016

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Out of >1,000,000 people living with HIV in the USA, an estimated 60% were not adequately engaged in medical care in 2011. In response, AIDS United spearheaded 12 HIV linkage and retention in care programs. These programs were supported by the Social Innovation Fund, a White House initiative. Each program reflected the needs of its local population living with HIV. Economic analyses of such programs, such as cost and cost threshold analyses, provide important information for policy-makers and others allocating resources or planning programs. Implementation costs were examined from societal and payer perspectives. This paper presents the results of cost threshold analyses, which provide an estimated number of HIV transmissions that would have to be averted for each program to be considered cost-saving and cost-effective. The methods were adapted from the US Panel on Cost-effectiveness in Health and Medicine. Per client program costs ranged from $1109.45 to $7602.54 from a societal perspective. The cost-saving thresholds ranged from 0.32 to 1.19 infections averted, and the cost-effectiveness thresholds ranged from 0.11 to 0.43 infections averted by the programs. These results suggest that such programs are a sound and efficient investment towards supporting goals set by US HIV policy-makers. Cost-utility data are pending.

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Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs

et al. 2016

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“…In addition to low coverage rates, the expansion of PMTCT services has been accompanied by significant rates of loss to follow-up (LTFU), defined as being absent from a health centre for more than three months following a scheduled appointment or service, among pregnant and post-partum women living with HIV. Efforts to prevent LTFU would both improve patient survival rates and be cost effective, according to an assessment conducted in Côte d'Ivoire (Losina et al, 2009).…”

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confidence: 99%

Exploring loss to follow-up among women living with HIV in Prevention of Mother to Child Transmission programmes in Côte d'Ivoire

Schechter¹,

Bakor²,

Koné

et al. 2014

Global Public Health

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The expansion of Prevention of Mother to Child Transmission (PMTCT) services globally has been accompanied by significant rates of loss to follow-up (LTFU). This study explored barriers and facilitators to participation in PMTCT programmes for pregnant and post-partum women living with HIV who had been LTFU at public sector antenatal care facilities in the Vallée du Bandama region of Côte d'Ivoire, West Africa. Three types of interviews were conducted at seven health sites: (1) individual or small group interviews with health staff; (2) one focus group with women actively enrolled in PMTCT services; and (3) individual interviews with women who had been LTFU from PMTCT services. Ten main themes emerged and were classified within a modified social ecological model. The individual level barriers included discouragement and internalised stigma, while hope for self/child's health was a facilitator. The family/community level barriers were fear of stigma and gender inequities. The health system level barriers were unclear information and poor post-test counselling, while staff advice and support groups were facilitators. The structural level barrier was associated costs. Factors on all four levels of the social ecological model must be addressed in order to maximise adherence to PMTCT services.

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“…The majority of those identified were [32], is likely to be cost-effective given savings derived from sustained treatment. In concentrated epidemics situated in high-and middle-income settings, far more is needed to identify effective test and treat campaigns, particularly among female sex workers (FSW) and MSM-with young MSM being a specific priority.…”

Section: Discussionmentioning

confidence: 99%

“…Each of these studies served as examples of innovative strategies to diagnose hard-to-reach clients in resource-limited settings. In the interest of optimizing retention in HIV care in such settings, Losina et al [32] estimated that eliminating antiretroviral therapy (ART) copayments and charges for opportunistic infections, along with personnel training and providing meals and travel reimbursements for clients, would be cost-effective.…”

Section: Cost-effective Interventions By Cascade Stage and Settingmentioning

confidence: 99%

Cost-effectiveness Analysis Along the Continuum of HIV Care: How Can We Optimize the Effect of HIV Treatment as Prevention Programs?

et al. 2014

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The cascade of HIV care has been proposed as a useful tool to monitor health system performance across the key stages of HIV care delivery to reduce morbidity, mortality, and HIV transmission, the focal points of HIV Treatment as Prevention campaigns. Interventions to improve the cascade at its various stages may vary substantially in their ability to deliver health value per amount expended. In order to meet global antiretroviral treatment access targets, there is an urgent need to maximize the value of health spending by prioritizing cost-effective interventions. We executed a literature review on economic evaluations of interventions to improve specific stages of the cascade of HIV care. In total, 33 articles met the criteria for inclusion in the review, 22 (67 %) of which were published within the last 5 years. Nonetheless, substantial gaps in our knowledge remain, particularly for interventions to improve linkage and retention in HIV care in developed and developing-world settings and generalized and concentrated epidemics. We make the case here that the attention of scientists and policymakers needs to turn to the development, implementation, and rigorous evaluation of interventions to improve the various stages of the cascade of HIV care.

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Cost-Effectiveness of Preventing Loss to Follow-up in HIV Treatment Programs: A Côte d'Ivoire Appraisal

Abstract: Based on data from West Africa, Elena Losina and colleagues predict that interventions to reduce dropout rates from HIV treatment programs (such as eliminating copayments) will be cost-effective.

Cited by 70 publications

References 46 publications

Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs

Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs

Exploring loss to follow-up among women living with HIV in Prevention of Mother to Child Transmission programmes in Côte d'Ivoire

Cost-effectiveness Analysis Along the Continuum of HIV Care: How Can We Optimize the Effect of HIV Treatment as Prevention Programs?

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