ArticleThe lancet. HIV2014
Effectiveness and cost-effectiveness of potential responses to future high levels of transmitted HIV drug resistance in antiretroviral drug-naive populations beginning treatment: modelling study and economic analysis.
Article in The lancet. HIV, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 3 syntheses or guidelines pooled it, 43 citations in OpenAlex.
- Simulation modeling for the design and evaluation of HIV drug resistance interventions: a systematic review of literature.BMC public health · 2026Pooled it
- Cost-effectiveness of routine viral load monitoring in low- and middle-income countries: a systematic review.Journal of the International AIDS Society · 2017Pooled it
- Geographic and temporal trends in the molecular epidemiology and genetic mechanisms of transmitted HIV-1 drug resistance: an individual-patient- and sequence-level meta-analysis.PLoS medicine · 2015Pooled it
- Health-Related Quality of Life Among People Living with HIV in Vietnam, a Three-Year Longitudinal Analysis.AIDS and behavior · 2025Trial
- Epidemiological dynamics and molecular characterization of HIV drug resistance in eastern China from 2020 to 2023.Frontiers in microbiology · 2024Article
- Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old.Diagnostics (Basel, Switzerland) · 2021Article
- Risk Factors of Drug Resistance and the Potential Risk of HIV-1 Transmission of Patients with ART Virological Failure: A Population-Based Study in Sichuan, China.Infection and drug resistance · 2021Article
- Short Communication: HIV-DRLink: A Tool for Reporting Linked HIV-1 Drug Resistance Mutations in Large Single-Genome Data Sets Using the Stanford HIV Database.AIDS research and human retroviruses · 2020Article
- Cost-effectiveness analysis of pre-ART HIV drug resistance testing in Kenyan women.EClinicalMedicine · 2020Article
- HIV-1 acquired drug resistance to integrase inhibitors in a cohort of antiretroviral therapy multi-experienced Mexican patients failing to raltegravir: a cross-sectional study.AIDS research and therapy · 2020Article
- Structural Design and Data Requirements for Simulation Modelling in HIV/AIDS: A Narrative Review.PharmacoEconomics · 2019Review
- HIV testing and counselling couples together for affordable HIV prevention in Africa.International journal of epidemiology · 2019Article
- Survey of Pretreatment HIV Drug Resistance and Genetic Transmission Network Analysis Among HIV Patients in a High Drug-Use Area of Southwest China.Current HIV research · 2019Article
- HIV drug resistance in sub-Saharan Africa: public health questions and the potential role of real-world data and mathematical modelling.Journal of virus eradication · 2018Article
- Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study.The lancet. HIV · 2018Article
- Adding an Artificial Tail-Anchor to a Peptide-Based HIV-1 Fusion Inhibitor for Improvement of Its Potency and Resistance Profile.Molecules (Basel, Switzerland) · 2017Article
- Combined interventions to reduce HIV incidence in KwaZulu-Natal: a modelling study.BMC infectious diseases · 2017Article
- Differentiated Human Immunodeficiency Virus RNA Monitoring in Resource-Limited Settings: An Economic Analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2017Article
- Impact of HIV Drug Resistance on HIV/AIDS-Associated Mortality, New Infections, and Antiretroviral Therapy Program Costs in Sub-Saharan Africa.The Journal of infectious diseases · 2017Article
- Antiretroviral therapy supply chain quality control and assurance in improving people living with HIV therapeutic outcomes in Cameroon.AIDS research and therapy · 2017Article
Corrections and comments
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Authors and funding
15 authors at 8 institutions in 5 countries.
Funding
Abstract
backgroundWith continued roll-out of antiretroviral therapy (ART) in resource-limited settings, evidence is emerging of increasing levels of transmitted drug-resistant HIV. We aimed to compare the effectiveness and cost-effectiveness of different potential public health responses to substantial levels of transmitted drug resistance.
methodsWe created a model of HIV transmission, progression, and the effects of ART, which accounted for resistance generation, transmission, and disappearance of resistance from majority virus in the absence of drug pressure. We simulated 5000 ART programmatic scenarios with different prevalence levels of detectable resistance in people starting ART in 2017 (t0) who had not previously been exposed to antiretroviral drugs. We used the model to predict cost-effectiveness of various potential changes in policy triggered by different prevalence levels of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) measured in the population starting ART.
findingsIndividual-level resistance testing before ART initiation was not generally a cost-effective option, irrespective of the cost-effectiveness threshold. At a cost-effectiveness threshold of US$500 per quality-adjusted life-year (QALY), no change in policy was cost effective (ie, no change in policy would involve paying less than $500 per QALY gained), irrespective of the prevalence of pretreatment NNRTI resistance, because of the increased cost of the policy alternatives. At thresholds of $1000 or higher, and with the prevalence of pretreatment NNRTI resistance greater than 10%, a policy to measure viral load 6 months after ART initiation became cost effective. The policy option to change the standard first-line treatment to a boosted protease inhibitor regimen became cost effective at a prevalence of NNRTI resistance higher than 15%, for cost-effectiveness thresholds greater than $2000.
interpretationCost-effectiveness of potential policies to adopt in response to different levels of pretreatment HIV drug resistance depends on competing budgetary claims, reflected in the cost-effectiveness threshold. Results from our model will help inform WHO recommendations on monitoring of HIV drug resistance in people starting ART.
fundingWHO (with funds provided by the Bill & Melinda Gates Foundation), CHAIN (European Commission).
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.