ArticleThe lancet. HIV2016
Home testing and counselling to reduce HIV incidence in a generalised epidemic setting: a mathematical modelling analysis.
Article in The lancet. HIV, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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14 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Modelling Methods of Economic Evaluations of HIV Testing Strategies in Sub-Saharan Africa: A Systematic Review.Applied health economics and health policy · 2023Pooled it
- Impact of voluntary testing on infectious disease epidemiology: A game theoretic approach.PloS one · 2023Article
- Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study.PLOS global public health · 2023Article
- Evaluation of a health education program for improving uptake of HIV self-testing by men in Rwanda: a pilot pragmatic randomized control trial.Pilot and feasibility studies · 2021Article
- Modeling the Impact of Social Determinants of Health on HIV.AIDS and behavior · 2021Article
- Cost and cost-effectiveness of a universal HIV testing and treatment intervention in Zambia and South Africa: evidence and projections from the HPTN 071 (PopART) trial.The Lancet. Global health · 2021Article
- Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness.Scientific reports · 2019Article
- Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: A Systematic Review.EClinicalMedicine · 2019Article
- Voluntary Community Human Immunodeficiency Virus Testing, Linkage, and Retention in Care Interventions in Kenya: Modeling the Clinical Impact and Cost-effectiveness.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Article
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- Expanding HIV testing and linkage to care in southwestern Uganda with community health extension workers.Journal of the International AIDS Society · 2017Article
- Universal test, treat, and keep: improving ART retention is key in cost-effective HIV control in Uganda.BMC infectious diseases · 2017Article
- Home testing and counselling with linkage to care.The lancet. HIV · 2016Article
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundHome HIV testing and counselling (HTC) achieves high levels of HIV testing and linkage to care. Periodic home HTC, particularly targeted to those with high HIV viral load, might facilitate expansion of antiretroviral therapy (ART) coverage. We used a mathematical model to assess the effect of periodic home HTC programmes on HIV incidence in KwaZulu-Natal, South Africa.
methodsWe developed a dynamic HIV transmission model with parameters, primary cost data, and measures of viral suppression collected from a prospective study of home HTC in KwaZulu-Natal. In our model, we assumed home HTC took place every 5 years with ART initiation for people with CD4 counts of 350 cells per μL or less. For individuals with CD4 counts of more than 350 cells per μL, we compared increasing ART coverage for those with 350-500 cells per μL with initiating treatment for those who have viral loads of more than 10 000 copies per mL.
findingsMaintaining the presently observed level of 36% viral suppression in HIV-positive people, HIV incidence decreases by 33·8% over 10 years. Home HTC every 5 years with linkage to care with ART initiation at CD4 counts of 350 cells per μL or less reduces HIV incidence by 40·6% over 10 years. Expansion of ART to people with CD4 counts of more than 350 cells per μL who also have a viral load of 10 000 copies per mL or more decreases HIV incidence by 51·6%, and this was the most cost-effective strategy for prevention of HIV infections at US$2960 per infection averted. Expansion of ART eligibility CD4 counts of 350-500 cells per μL is cost-effective at $900 per quality-adjusted life-year gained. Following health economic guidelines, expansion of ART use to individuals who have viral loads of more than 10 000 copies per mL among those with CD4 counts of more than 350 cells per μL was cost-effective to reduce HIV-related morbidity.
interpretationOur results show that province-wide home HTC every 5 years can be a cost-effective strategy to increase ART coverage and reduce HIV burden. Expanded ART initiation criteria that includes individuals with high viral load will improve the effectiveness of home HTC in linking individuals to ART who are at high risk of transmitting HIV, thereby preventing morbidity and onward transmission.
fundingNational Institutes of Health.
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