ArticleBMC infectious diseases2017
Universal test, treat, and keep: improving ART retention is key in cost-effective HIV control in Uganda.
Article in BMC infectious diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The costs of scaling up HIV and syphilis testing in low- and middle-income countries: a systematic review.Health policy and planning · 2021Pooled it
- Calibration of individual-based models to epidemiological data: A systematic review.PLoS computational biology · 2020Pooled it
- Routine versus Targeted Viral Load Strategy among Patients Starting Antiretroviral in Hanoi, Vietnam.Journal of the International AIDS Society · 2019Trial
- Results from a proactive follow-up intervention to improve linkage and retention among people living with HIV in Uganda: a pre-/post- study.BMC health services research · 2018Trial
- Characteristics of Individuals With Advanced HIV Disease and Risk Factors for Mortality in a Contemporary Cohort in South Africa.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- How much does it cost to retain clients on antiretroviral treatment for one year in a large, public clinic? Routine financial costs of retention interventions at Lighthouse Trust in Lilongwe, Malawi.BMC research notes · 2025Article
- Leaving no one behind: Disability and HIV prevention, knowledge among adults in a population cohort in Uganda.African journal of disability · 2024Article
- "African geographical review · 2024Article
- How much does it cost to retain antiretroviral therapy (ART) clients in care? Routine financial costs of retention interventions at Lighthouse Trust's Martin Preuss Centre (MPC) in Lilongwe, Malawi.Research square · 2023Article
- Transmission reduction, health benefits, and upper-bound costs of interventions to improve retention on antiretroviral therapy: a combined analysis of three mathematical models.The Lancet. Global health · 2022Article
- Challenges in estimation, uncertainty quantification and elicitation for pandemic modelling.Epidemics · 2022Article
- High Burden of Cryptococcal Meningitis Among Antiretroviral Therapy-Experienced Human Immunodeficiency Virus-Infected Patients in Northern Uganda in the Era of "Test and Treat": Implications for Cryptococcal Screening Programs.Open forum infectious diseases · 2022Article
- June: open-source individual-based epidemiology simulation.Royal Society open science · 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
- Health outcomes and cost-effectiveness of treating depression in people with HIV in Sub-Saharan Africa: a model-based analysis.AIDS care · 2021Article
- FAVITES: simultaneous simulation of transmission networks, phylogenetic trees and sequences.Bioinformatics (Oxford, England) · 2019Article
- Retention on antiretroviral therapy during Universal Test and Treat implementation in Zomba district, Malawi: a retrospective cohort study.Journal of the International AIDS Society · 2019Article
- The impact of PEPFAR transition on HIV service delivery at health facilities in Uganda.PloS one · 2019Article
- Mathematical modelling to inform 'treat all' implementation in sub-Saharan Africa: a scoping review.Journal of virus eradication · 2018Article
- Bayesian uncertainty analysis for complex systems biology models: emulation, global parameter searches and evaluation of gene functions.BMC systems biology · 2018Article
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Authors and funding
10 authors.
Funding
Abstract
backgroundWith ambitious new UNAIDS targets to end AIDS by 2030, and new WHO treatment guidelines, there is increased interest in the best way to scale-up ART coverage. We investigate the cost-effectiveness of various ART scale-up options in Uganda.
methodsIndividual-based HIV/ART model of Uganda, calibrated using history matching. 22 ART scale-up strategies were simulated from 2016 to 2030, comprising different combinations of six single interventions (1. increased HIV testing rates, 2. no CD4 threshold for ART initiation, 3. improved ART retention, 4. increased ART restart rates, 5. improved linkage to care, 6. improved pre-ART care). The incremental net monetary benefit (NMB) of each intervention was calculated, for a wide range of different willingness/ability to pay (WTP) per DALY averted (health-service perspective, 3% discount rate).
resultsFor all WTP thresholds above $210, interventions including removing the CD4 threshold were likely to be most cost-effective. At a WTP of $715 (1 × per-capita-GDP) interventions to improve linkage to and retention/re-enrolment in HIV care were highly likely to be more cost-effective than interventions to increase rates of HIV testing. At higher WTP (> ~ $1690), the most cost-effective option was 'Universal Test, Treat, and Keep' (UTTK), which combines interventions 1-5 detailed above.
conclusionsOur results support new WHO guidelines to remove the CD4 threshold for ART initiation in Uganda. With additional resources, this could be supplemented with interventions aimed at improving linkage to and/or retention in HIV care. To achieve the greatest reductions in HIV incidence, a UTTK policy should be implemented.
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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.