Cost-Effectiveness of the ‘One4All’ HIV Linkage Intervention in Guangxi Zhuang Autonomous Region, China

Abstract

BackgroundIn Guangxi Zhuang Autonomous Region, China, an estimated 80% of newly-identified antiretroviral therapy (ART)-eligible patients are not engaged in ART. Delayed ART uptake ultimately translates into high rates of HIV morbidity, mortality, and transmission. To enhance HIV testing receipt and subsequent treatment uptake in Guangxi, the Chinese Center for Disease Control and Prevention (CDC) executed a cluster-randomized trial to assess the effectiveness and cost-effectiveness of a streamlined HIV testing algorithm (the One4All intervention) in 12 county-level hospitals.ObjectiveTo determine the incremental cost-effectiveness of the One4All intervention delivered at county hospitals in Guangxi, China, compared to the current standard of care (SOC).PerspectiveHealth System.Time Horizon1-, 5-and 25-years.MethodsWe adapted a dynamic, compartmental HIV transmission model to simulate HIV transmission and progression in Guangxi, China and identify the economic impact and health benefits of implementing the One4All intervention in all Guangxi hospitals. The One4All intervention algorithm entails rapid point-of-care HIV screening, CD4 and viral load testing of individuals presenting for HIV screening, with same-day results and linkage to counselling. We populated the model with data from the One4All trial (CTN-0056), China CDC HIV registry and published reports. Model outcomes were HIV incidence, mortality, costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) of the One4All intervention compared to SOC.ResultsThe One4All testing intervention was more costly than SOC (CNY 2,182 vs. CNY 846), but facilitated earlier ART access, resulting in delayed disease progression and mortality. Over a 25-year time horizon, we estimated that introducing One4All in Guangxi would result in 802 averted HIV cases and 1629 averted deaths at an ICER of CNY 11,678 per QALY gained. Sensitivity analysis revealed that One4All remained cost-effective at even minimal levels of effectiveness. Results were robust to changes to a range of parameters characterizing the HIV epidemic over time.ConclusionsThe One4All HIV testing strategy was highly cost-effective by WHO standards, and should be prioritized for widespread implementation in Guangxi, China. Integrating the intervention within a broader combination prevention strategy would enhance the public health response to HIV/AIDS in Guangxi.

Development and Calibration of a Dynamic HIV Transmission Model for 6 US Cities

“…We adapted and extended a previously published HIV dynamic transmission model that was used to estimate the health benefits and costs of HIV prevention and treatment interventions in the United States [12][13][14] ; British Columbia, Canada [15][16][17] ; and Guangxi province, China. 18 We modified the compartmental model both to accommodate the distinctive features in HIV microepidemics across US cities 4 and to allow for assessment of a range of HIV treatment and prevention interventions to be evaluated jointly in future applications. For each demonstration city, the adult population aged 15 to 64 years was partitioned into compartments on the basis of biological sex, race/ethnicity (black/ African American [black], Hispanic/Latino [Hispanic], and non-Hispanic white/others [white]), and HIV risk behavior type (MSM, people who inject drugs [PWID], MSM-PWID, and heterosexual [HET]).…”

Liver damage in patients living with HIV on antiretroviral treatment with normal baseline liver function and without HBV/HCV infection: an 11-year retrospective cohort study in Guangxi, China

“…Guangxi Zhuang Autonomous Region, a province in western China, has the second highest HIV-infected reported cases in China, with more than 100 000 reported HIV/AIDS cases by the end of 2016,16 which accounting for ~13% of total national HIV/AIDS cases. Guigang city is a prefecture-level city in Guangxi, and there were more than 5000 reported HIV/AIDS cases during 2008–2013, which listed in the top five among all cities in Guangxi 17.…”

Testing and linkage to HIV care in China: a cluster-randomised trial

“…2,4,25 Taken together with clinical trial results showing benefit to treating all people with HIV regardless of CD4 count or clinical stage, 26,27 our results strongly suggest that a change in approach to provision of treatment for HIV is warranted. Moreover, a study published during the preparation of our manuscript 28 found that the One4All strategy was highly cost-effective, and remained so when tested under various scenarios related to changes in the HIV epidemic over time.…”