Evidence for scaling up HIV treatment in sub-Saharan Africa: A call for incorporating health system constraints

Mikkelsen, Evelinn; Hontelez, Jan A. C.; Jansen, Maarten; Bärnighausen, Till; Hauck, Katharina; Johansson, Kjell Arne; Meyer‐Rath, Gesine; Over, Mead; Vlas, Sake J. de; Wilt, Gert Jan van der; Tromp, Noor; Bijlmakers, Leon; Baltussen, Rob

doi:10.1371/journal.pmed.1002240

Cited by 45 publications

(45 citation statements)

References 9 publications

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“…Hence we do not oppose, but instead welcome efforts to integrate evidence on multiple criteria as is the case in the extended cost-effectiveness analysis approach. 5,8,9 Nevertheless, we agree with Chalkidou et al and would like to highlight again that “global approaches to CEA can hardly be too context-sensitive” for the very reason that “studies done by global players that ignore local contexts but nonetheless presume to advise may undermine local priorities and distort local spending decisions.” 7 We furthermore applaud WHO for providing broader support and guidance to countries. 5 Yet, we observe in practice that cost-effectiveness is often considered the dominant criterion when used in priority setting.…”

supporting

confidence: 68%

Evidence-Informed Deliberative Processes – Early Dialogue, Broad Focus and Relevance: A Response to Recent Commentaries

Jansen¹,

Baltussen²,

Mikkelsen³

et al. 2017

Int J Health Policy Manag

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supporting

confidence: 68%

Evidence-Informed Deliberative Processes – Early Dialogue, Broad Focus and Relevance: A Response to Recent Commentaries

Jansen¹,

Baltussen²,

Mikkelsen³

et al. 2017

Int J Health Policy Manag

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“…integrated care). Addressing these gaps will facilitate policy‐relevant modelling projections that inform cost‐effectiveness of individual interventions, the affordability of these interventions, and allocative efficiency across interventions when resources are constrained . Research approaches : The development of country‐specific mathematical models can provide projections of health and economic outcomes related to Treat All, including budget impact, which is essential information for programme planning and decision‐making. A key component of this effort is incorporating realistic model assumptions and inputs that reflect local treatment and care patterns.…”

Section: Resultsmentioning

confidence: 99%

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

et al. 2019

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Introduction “Treat All” – the treatment of all people with HIV, irrespective of disease stage or CD4 cell count – represents a paradigm shift in HIV care that has the potential to end AIDS as a public health threat. With accelerating implementation of Treat All in sub‐Saharan Africa (SSA), there is a need for a focused agenda and research to identify and inform strategies for promoting timely uptake of HIV treatment, retention in care, and sustained viral suppression and addressing bottlenecks impeding implementation. Methods The Delphi approach was used to develop consensus around research priorities for Treat All implementation in SSA. Through an iterative process (June 2017 to March 2018), a set of research priorities was collectively formulated and refined by a technical working group and shared for review, deliberation and prioritization by more than 200 researchers, implementation experts, policy/decision‐makers, and HIV community representatives in East, Central, Southern and West Africa. Results and discussion The process resulted in a list of nine research priorities for generating evidence to guide Treat All policies, implementation strategies and monitoring efforts. These priorities highlight the need for increased focus on adolescents, men, and those with mental health and substance use disorders – groups that remain underserved in SSA and for whom more effective testing, linkage and care strategies need to be identified. The priorities also reflect consensus on the need to: (1) generate accurate national and sub‐national estimates of the size of key populations and describe those who remain underserved along the HIV‐care continuum; (2) characterize the timeliness of HIV care and short‐ and long‐term HIV care continuum outcomes, as well as factors influencing timely achievement of these outcomes; (3) estimate the incidence and prevalence of HIV‐drug resistance and regimen switching; and (4) identify cost‐effective and affordable service delivery models and strategies to optimize uptake and minimize gaps, disparities, and losses along the HIV‐care continuum, particularly among underserved populations. Conclusions Reflecting consensus among a broad group of experts, researchers, policy‐ and decision‐makers, PLWH, and other stakeholders, the resulting research priorities highlight important evidence gaps that are relevant for ministries of health, funders, normative bodies and research networks.

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“…16 Additionally, our findings provide an example to support the broader calls for model-based economic evaluations to formally consider uncertainty (and the additional costs) of implementation of new diagnostic technologies in general. 30 Our study has several limitations. First, the methods to account for clustering and imbalance can generate narrower CIs than with other more complex and timeconsuming methods such as multilevel modelling, even if they produce unbiased estimates of the mean incremental cost-effectiveness ratio.…”

Section: Discussionmentioning

confidence: 91%

Cost-effectiveness of Xpert MTB/RIF for tuberculosis diagnosis in South Africa: A real-world cost analysis and economic evaluation

2017

Indian Journal of Tuberculosis

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Evidence for scaling up HIV treatment in sub-Saharan Africa: A call for incorporating health system constraints

Abstract: Jan Hontelez and colleagues argue that the cost-effectiveness studies of HIV treatment scale-up need to include health system constraints to be more informative.

Cited by 45 publications

References 9 publications

Evidence-Informed Deliberative Processes – Early Dialogue, Broad Focus and Relevance: A Response to Recent Commentaries

Evidence-Informed Deliberative Processes – Early Dialogue, Broad Focus and Relevance: A Response to Recent Commentaries

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

Cost-effectiveness of Xpert MTB/RIF for tuberculosis diagnosis in South Africa: A real-world cost analysis and economic evaluation

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