Cost-effectiveness of Zvandiri, a community-based support intervention to reduce virological failure in adolescents living with HIV in Zimbabwe: Results of a decision analytical model

Collin Mangenah, Webster Mavhu, Nicola Willis, Juliet Mufuka, Sarah Bernays, Walter Mangezi, Tsitsi Apollo, Ricardo Araya, Helen A Weiss, Alfredo Palacios, Fern Terris-Prestholt, Frances M Cowan and Hendramoorthy Maheswaran

PLOS Global Public Health, 2025, vol. 5, issue 12, 1-18

Abstract: Improving antiretroviral therapy (ART) adherence among adolescents living with HIV (ALHIV) improves outcomes, but with resource implications. We conducted a cost-effectiveness analysis extrapolating the costs and benefits of a community-based peer-support intervention (Zvandiri) among ALHIV in Zimbabwe. We used a de-novo multistate Markov decision-analytic model that simulated Zvandiri lifetime costs and benefits on viral suppression, death rates, life-years (LY) and quality-adjusted-life-years (QALYs) gained from the healthcare system perspective. We estimate the incremental cost-effectiveness ratio (ICER) per LY and QALY gained and compare the ICER to proposed cost-effectiveness thresholds of $500 and $700 per LY or QALY gained. We explore parameter uncertainty using probabilistic sensitivity analyses. Cohort-microsimulation suggests that after 40 years under SoC, 21% of 280 ALHIV will have undetectable viral-load (VL), 12% will have low VL (

Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pgph00:0005545

DOI: 10.1371/journal.pgph.0005545

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