Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: a health economics modelling study

Sahu, Maitreyi; Bayer, Cara J.; Roberts, D. Allen; Rooyen, Heidi van; Heerden, Alastair van; Shahmanesh, Maryam; Asiimwe, Stephen; Sausi, Kombi; Sithole, Nsika; Ying, Roger; Rao, Darcy White; Krows, Meighan; Shapiro, Adrienne E.; Baeten, Jared M.; Celum, Connie; Revill, Paul; Barnabas, Ruanne V.

doi:10.1101/2022.05.18.22275272

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…TPT uptake was higher among participants who received community‐based care [ 19 ]. A recent modelling analysis concluded that community‐based HIV treatment was cost‐effective in preventing death and disability due to HIV [ 20 ]. However, the impacts of increased ART and TPT uptake on incident TB and TB deaths were not quantified among trial participants, nor among the surrounding community.…”

Section: Introductionmentioning

confidence: 99%

Preventing tuberculosis with community‐based care in an HIV‐endemic setting: a modelling analysis

Ross,

Greene,

Broshkevitch

et al. 2024

J Int AIDS Soc.

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IntroductionAntiretroviral therapy (ART) and tuberculosis preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community‐based care, can increase the uptake of ART and TPT to prevent TB in settings with a high burden of HIV‐associated TB, particularly among men.MethodsWe developed a gender‐stratified dynamic model of TB and HIV transmission and disease progression among 100,000 adults ages 15−59 in KwaZulu‐Natal, South Africa. We drew model parameters from a community‐based ART initiation and resupply trial in sub‐Saharan Africa (Delivery Optimization for Antiretroviral Therapy, DO ART) and other scientific literature. We simulated the impacts of community‐based ART and TPT care programmes during 2018−2027, assuming that community‐based ART and TPT care were scaled up to similar levels as in the DO ART trial (i.e. ART coverage increasing from 49% to 82% among men and from 69% to 83% among women) and sustained for 10 years. We projected the number of TB cases, deaths and disability‐adjusted life years (DALYs) averted relative to standard, clinic‐based care. We calculated programme costs and incremental cost‐effectiveness ratios from the provider perspective.ResultsIf community‐based ART care could be implemented with similar effectiveness to the DO ART trial, increased ART coverage could reduce TB incidence by 27.0% (range 21.3%−34.1%) and TB mortality by 34.6% (range 24.8%–42.2%) after 10 years. Increasing both ART and TPT uptake through community‐based ART with TPT care could reduce TB incidence by 29.7% (range 23.9%−36.0%) and TB mortality by 36.0% (range 26.9%−43.8%). Community‐based ART with TPT care reduced gender disparities in TB mortality rates, with a projected 54 more deaths annually among men than women (range 11–103) after 10 years of community‐based care versus 109 (range 41–182) in standard care. Over 10 years, the mean cost per DALY averted by community‐based ART with TPT care was $846 USD (range $709–$1012).ConclusionsBy substantially increasing coverage of ART and TPT, community‐based care for people living with HIV could reduce TB incidence and mortality in settings with high burdens of HIV‐associated TB and reduce TB gender disparities.

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Section: Introductionmentioning

confidence: 99%

Preventing tuberculosis with community‐based care in an HIV‐endemic setting: a modelling analysis

Ross,

Greene,

Broshkevitch

et al. 2024

J Int AIDS Soc.

Self Cite

View full text Add to dashboard Cite

show abstract

“…TPT uptake was higher among participants who received community-based care than participants who received facility-based care [19]. A recent modelling analysis concluded that community-based HIV treatment was cost-effective in preventing death and disability due to HIV [20]. However, the longer-term impact of increased ART and TPT uptake on incident TB and TB deaths were not quantified among trial participants, nor were TB incidence or deaths quantified among community members who were not in the trial.…”

Section: Introductionmentioning

confidence: 99%

Preventing tuberculosis with community-based care in an HIV-endemic setting: a modeling analysis

Ross,

Greene,

Bayer

et al. 2023

Preprint

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IntroductionAntiretroviral therapy (ART) and TB preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community-based care, can increase uptake of ART and TPT to prevent TB in settings with a high burden of HIV-associated TB, particularly among men.MethodsWe developed a gender-stratified dynamic model of TB and HIV transmission and disease progression among 100,000 adults ages 15-59 in KwaZulu-Natal, South Africa. We drew model parameters from a community-based ART initiation and resupply trial in sub-Saharan Africa (Delivery Optimization for Antiretroviral Therapy, DO ART) and other scientific literature. We simulated the impacts of community-based ART and TPT care programs during 2018-2027, assuming that community-based ART and TPT care were scaled up to similar levels as in the DO ART trial (i.e., ART coverage increasing from 49% to 82% among men and from 69% to 83% among women) and sustained for ten years. We projected the number of TB cases, deaths, and disability-adjusted life years (DALYs) averted relative to standard, clinic-based care. We calculated program costs and incremental cost-effectiveness ratios from the provider perspective.ResultsIf community-based ART care could be implemented with similar effectiveness to the DO ART trial, increased ART coverage could reduce TB incidence by 27.0% (range 21.3% - 34.1%) and TB mortality by 36.0% (range 26.9% - 43.8%) after ten years. Increasing both ART and TPT uptake through community-based ART with TPT care could reduce TB incidence by 29.7% (range 23.9% - 36.0%) and TB mortality by 36.0% (range 26.9% - 43.8%). Community-based ART with TPT care reduced gender disparities in TB mortality rates by reducing TB mortality among men by a projected 39.8% (range 32.2% - 46.3%) and by 30.9% (range 25.3% - 36.5%) among women. Over ten years, the mean cost per DALY averted by community-based ART with TPT care was $846 USD (range $709 - $1,012).ConclusionsBy substantially increasing coverage of ART and TPT, community-based care for people living with HIV could reduce TB incidence and mortality in settings with high burdens of HIV-associated TB and reduce TB gender disparities.

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Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: a health economics modelling study

Cited by 2 publications

References 29 publications

Preventing tuberculosis with community‐based care in an HIV‐endemic setting: a modelling analysis

Preventing tuberculosis with community‐based care in an HIV‐endemic setting: a modelling analysis

Preventing tuberculosis with community-based care in an HIV-endemic setting: a modeling analysis

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