Clinical Impact and Cost-Effectiveness of Expanded Voluntary HIV Testing in India

Kartik K Venkatesh, Jessica E Becker, Nagalingeswaran Kumarasamy, Yoriko M Nakamura, Kenneth H Mayer, Elena Losina, Soumya Swaminathan, Timothy P Flanigan, Rochelle P Walensky and Kenneth A Freedberg

PLOS ONE, 2013, vol. 8, issue 5, 1-11

Abstract: Background: Despite expanding access to antiretroviral therapy (ART), most of the estimated 2.3 to 2.5 million HIV-infected individuals in India remain undiagnosed. The questions of whom to test for HIV and at what frequency remain unclear. Methods: We used a simulation model of HIV testing and treatment to examine alternative HIV screening strategies: 1) current practice, 2) one-time, 3) every five years, and 4) annually; and we applied these strategies to three population scenarios: 1) the general Indian population (“national population”), i.e. base case (HIV prevalence 0.29%; incidence 0.032/100 person-years [PY]); 2) high-prevalence districts (HIV prevalence 0.8%; incidence 0.088/100 PY), and 3) high-risk groups (HIV prevalence 5.0%; incidence 0.552/100 PY). Cohort characteristics reflected Indians reporting for HIV testing, with a median age of 35 years, 66% men, and a mean CD4 count of 305 cells/µl. The cost of a rapid HIV test was $3.33. Outcomes included life expectancy, HIV-related direct medical costs, incremental cost-effectiveness ratios (ICERs), and secondary transmission benefits. The threshold for “cost-effective” was defined as 3x the annual per capita GDP of India ($3,900/year of life saved [YLS]), or for “very cost-effective” was

Date: 2013
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0064604

DOI: 10.1371/journal.pone.0064604

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