ArticleThe lancet. HIV2015
Cost-effectiveness of community-based strategies to strengthen the continuum of HIV care in rural South Africa: a health economic modelling analysis.
Article in The lancet. HIV, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 4 of them syntheses that pooled it.
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Who cites it
60 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Pooled it
- Costs of HIV testing services in sub-Saharan Africa: a systematic literature review.BMC infectious diseases · 2024Pooled it
- Modelling Methods of Economic Evaluations of HIV Testing Strategies in Sub-Saharan Africa: A Systematic Review.Applied health economics and health policy · 2023Pooled it
- The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case.PloS one · 2019Pooled it
- Cost-Effectiveness of Linkage Case Management for Hospitalized People With HIV.JAMA network open · 2025Trial
- Novel Use of Video Logs to Deliver Educational Interventions to Black Women for Disease Prevention.The western journal of emergency medicine · 2022Trial
- Impact of an educational digital storytelling intervention on HIV risk perception among Nigerian adolescents.The Journal of international medical research · 2020Trial
- Assisted partner notification services are cost-effective for decreasing HIV burden in western Kenya.AIDS (London, England) · 2018Trial
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- Trial
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- Cost-effectiveness of a smart pillbox intervention for adherence to oral HIV pre-exposure prophylaxis.Nature communications · 2026Article
- Effect of facility- versus community-based HIV testing services on the diagnosis of advanced HIV disease in Uganda: a quasi-experimental study.BMC infectious diseases · 2025Article
- An Enhanced Retention Strategy to Prevent the Vertical Transmission of HIV in Uganda: A Budget Impact Analysis.PharmacoEconomics - open · 2025Article
- Feasibility and Acceptability of Diabetes and Hypertension Screening and Diagnosis by Community Health Workers in Rural Lesotho: A Mixed-Methods Pilot Study.Annals of global health · 2025Article
- Agent based modelling of blood borne viruses: a scoping review.BMC infectious diseases · 2024Article
- Protocol for the economic evaluation of integrated community-based care compared with integrated facility-based care for HIV, hypertension and diabetes in Tanzania and Uganda (INTE-COMM trial).NIHR open research · 2024Article
- The Infomóvel-An information system for managing HIV/AIDS patients in rural areas of Mozambique.BMC medical informatics and decision making · 2023Observational
- Costs and cost-effectiveness of HIV counselling and testing modalities in Southern Mozambique.Cost effectiveness and resource allocation : C/E · 2022Article
- Community-based referral for tuberculosis preventive therapy is effective for treatment completion.PLOS global public health · 2022Article
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8 authors.
Funding
Abstract
backgroundHome HIV counselling and testing (HTC) achieves high coverage of testing and linkage to care compared with existing facility-based approaches, particularly among asymptomatic individuals. In a modelling analysis we aimed to assess the effect on population-level health and cost-effectiveness of a community-based package of home HTC in KwaZulu-Natal, South Africa.
methodsWe parameterised an individual-based model with data from home HTC and linkage field studies that achieved high coverage (91%) and linkage to antiretroviral therapy (80%) in rural KwaZulu-Natal, South Africa. Costs were derived from a linked microcosting study. The model simulated 10,000 individuals over 10 years and incremental cost-effectiveness ratios were calculated for the intervention relative to the existing status quo of facility-based testing, with costs discounted at 3% annually.
findingsThe model predicted implementation of home HTC in addition to current practice to decrease HIV-associated morbidity by 10–22% and HIV infections by 9–48% with increasing CD4 cell count thresholds for antiretroviral therapy initiation. Incremental programme costs were US$2·7 million to $4·4 million higher in the intervention scenarios than at baseline, and costs increased with higher CD4 cell count thresholds for antiretroviral therapy initiation; antiretroviral therapy accounted for 48–87% of total costs. Incremental cost-effectiveness ratios per disability-adjusted life-year averted were $1340 at an antiretroviral therapy threshold of CD4 count lower than 200 cells per μL, $1090 at lower than 350 cells per μL, $1150 at lower than 500 cells per μL, and $1360 at universal access to antiretroviral therapy.
interpretationCommunity-based HTC with enhanced linkage to care can result in increased HIV testing coverage and treatment uptake, decreasing the population burden of HIV-associated morbidity and mortality. The incremental cost-effectiveness ratios are less than 20% of South Africa's gross domestic product per person, and are therefore classed as very cost effective. Home HTC can be a viable means to achieve UNAIDS' ambitious new targets for HIV treatment coverage.
fundingNational Institutes of Health, Bill & Melinda Gates Foundation, Wellcome Trust.
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