Projecting the Epidemiological Effect, Cost-Effectiveness & Transmission of HIV Drug Resistance in Vietnam Associated with Viral Load Monitoring Strategies
OBJECTIVES:
The objective
of this study was to investigate the potential epidemiological impact of viral load
(VL) monitoring and its cost-effectiveness in Vietnam, where transmitted HIV drug resistance (TDR) prevalence has increased from
<5% to 5%-15% in the past decade.
METHODS:
Using a population-based
mathematical model driven by data from Vietnam, we simulated scenarios of various
combinations of VL testing coverage, VL thresholds for second-line ART initiation
and availability of HIV drug-resistance
tests. We assessed the cost per disability-adjusted life year (DALY) averted for
each scenario.
RESULTS:
Projecting
expected ART scale-up levels, to approximately double the number of people on ART
by 2030, will lead to an estimated 18 510 cases (95% CI: 9120-34 600 cases) of TDR
and 55 180 cases (95% CI: 40 540-65 900 cases) of acquired drug resistance (ADR)
in the absence of VL monitoring. This projection corresponds to a TDR prevalence
of 16% (95% CI: 11%-24%) and ADR of 18% (95% CI: 15%-20%). Annual or biennial VL
monitoring with 30% coverage is expected to relieve 12%-31% of TDR (2260-5860 cases),
25%-59% of ADR (9620-22 650 cases), 2%-6% of HIV-related deaths (360-880 cases) and 19 270-51 400
DALYs during 2015-30. The 30% coverage of VL monitoring is estimated to cost US$4848-5154
per DALY averted. The projected additional cost for implementing this strategy is
US$105-268 million over 2015-30.
CONCLUSIONS:
Our
study suggests that a programmatically achievable 30% coverage of VL monitoring
can have considerable benefits for individuals and leads to population health benefits
by reducing the overall national burden of HIV drug
resistance. It is marginally cost-effective according to common willingness-to-pay
thresholds.
- 1Disease Modelling and Financing Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam.
- 2Disease Modelling and Financing Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
- 3Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam.
- 4Department of HIV Care and Treatment, Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam.
- 5Department of Laboratory Analysis, Pasteur Institute, Ho Chi Minh City, Vietnam.
- 6Ministry of Health, Hanoi, Vietnam.
- 7Disease Modelling and Financing Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Research Center for Public Health, School of Medicine, Tsinghua University, China Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia lzhang@kirby.unsw.edu.au.
- J Antimicrob Chemother. 2016 Feb 10. pii: dkv473.
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