Evidence map›Paper›PMID 29174084›Full record

ArticleThe lancet. HIV2018

Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study.

Andrew N Phillips, Valentina Cambiano, Fumiyo Nakagawa, Paul Revill, Michael R Jordan, Timothy B Hallett, Meg Doherty, Andrea De Luca, Jens D Lundgren, Mutsa Mhangara and 16 more

Registry-linked trialOpen access · hybridAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The lancet. HIV, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04453436 (HIV Drug Resistance Profiles Among Individuals Failing Tenofovir/Lamivudine and Dolutegravir First Line Regimen in Brazil), which is not on this map. Cited by 49 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
49citing papers in PubMed, 3 pooled it
6.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT04453436 active not recruitingnot on this mapstarted 2023, after this paper: background citation

HIV Drug Resistance Profiles Among Individuals Failing Tenofovir/Lamivudine and Dolutegravir First Line Regimen in Brazil

Typeobservational_patient_registrySponsorFederal University of São PauloRan2023 to 2026Enrolled2,500ConditionsHIV, Drug, ResistanceArmsTenofovir Disoproxil
3 · Its place in the literature

Who cites it

49 citing papers in PubMed, 3 syntheses or guidelines pooled it, 76 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

26 authors at 17 institutions in 9 countries.

Andrew N PhillipsInstitute for Global Health, University College London, London, UK. Electronic address: andrew.phillips@ucl.ac.uk.
Valentina CambianoInstitute for Global Health, University College London, London, UK.
Fumiyo NakagawaInstitute for Global Health, University College London, London, UK.
Paul RevillUniversity of York, York, UK.
Michael R JordanTufts University, Boston, MA, USA.
Timothy B HallettImperial College London, London, UK.
Meg DohertyWHO, Geneva, Switzerland.
Andrea De LucaUniversity of Siena, Siena, Italy.
Jens D LundgrenRigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Mutsa MhangaraMinistry of Health & Child Care, Harare, Zimbabwe.
Tsitsi ApolloMinistry of Health & Child Care, Harare, Zimbabwe.
John MellorsUniversity of Pittsburgh, Pittsburgh, PA, USA.
Brooke NicholsDepartment of Global Health, Boston University School of Public Health, Boston, MA, USA.
Urvi ParikhUniversity of Pittsburgh, Pittsburgh, PA, USA.
Deenan PillayAfrica Health Research Institute, KwaZulu Natal, South Africa; Division of Infection and Immunity, University College London, London, UK.
Tobias Rinke de WitAmsterdam Institute for Global Health & Development, San Francisco, CA, USA.
Kim SigaloffAmsterdam Institute for Global Health & Development, San Francisco, CA, USA.
Diane HavlirUniversity of California San Francisco, San Francisco, CA, USA.
Daniel R KuritzkesBrigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Anton PozniakChelsea & Westminster Hospital NHS Trust, London, UK.
David van de VijverErasmus Medical Centre, Rotterdam, Netherlands.
Marco VitoriaWHO, Geneva, Switzerland.
Mark A WainbergMontreal Jewish General Hospital, Montreal, QC, Canada.
Elliot RaizesCenters for Disease Control and Prevention, Atlanta, GA, USA.
Silvia BertagnolioWHO, Geneva, Switzerland.
Working Group on Modelling Potential Responses to High Levels of Pre-ART Drug Resistance in Sub-Saharan Africa
University College London · GBWorld Health Organization · CHMinistry of Health and Child Welfare · ZWUniversity of Pittsburgh · USBoston University · USCenters for Disease Control and Prevention · USChelsea and Westminster Hospital · GBErasmus University Rotterdam · NLImperial College London · GBJewish General Hospital · CATufts University · USUniversity of California, San Francisco · USUniversity of Copenhagen · DKUniversity of Siena · ITUniversity of York · GBBrigham and Women's Hospital · USHarvard University · US

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundThere is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating antiretroviral therapy (ART) in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health responses in countries in sub-Saharan Africa where the prevalence of pretreatment drug resistance to NNRTIs is high.

methodsThe HIV Synthesis Model is an individual-based simulation model of sexual HIV transmission, progression, and the effect of ART in adults, which is based on extensive published data sources and considers specific drugs and resistance mutations. We used this model to generate multiple setting scenarios mimicking those in sub-Saharan Africa and considered the prevalence of pretreatment NNRTI drug resistance in 2017. We then compared effectiveness and cost-effectiveness of alternative policy options. We took a 20 year time horizon, used a cost effectiveness threshold of US$500 per DALY averted, and discounted DALYs and costs at 3% per year.

findingsA transition to use of a dolutegravir as a first-line regimen in all new ART initiators is the option predicted to produce the most health benefits, resulting in a reduction of about 1 death per year per 100 people on ART over the next 20 years in a situation in which more than 10% of ART initiators have NNRTI resistance. The negative effect on population health of postponing the transition to dolutegravir increases substantially with higher prevalence of HIV drug resistance to NNRTI in ART initiators. Because of the reduced risk of resistance acquisition with dolutegravir-based regimens and reduced use of expensive second-line boosted protease inhibitor regimens, this policy option is also predicted to lead to a reduction of overall programme cost.

interpretationA future transition from first-line regimens containing efavirenz to regimens containing dolutegravir formulations in adult ART initiators is predicted to be effective and cost-effective in low-income settings in sub-Saharan Africa at any prevalence of pre-ART NNRTI resistance. The urgency of the transition will depend largely on the country-specific prevalence of NNRTI resistance.

fundingBill & Melinda Gates Foundation, World Health Organization.

Indexed as

AdolescentAdultAfrica South of the SaharaCost-Benefit AnalysisDolutegravirHealth PolicyHeterocyclic Compounds, 3-RingHIV InfectionsHIV Integrase InhibitorsHumansMiddle AgedModels, EconomicOxazinesPiperazinesPublic HealthPyridonesDolutegravirHeterocyclic Compounds, 3-RingHIV Integrase InhibitorsOxazinesPiperazinesPyridones

Identifiers

PMID29174084
PMCPMC5843989
OpenAlexW2768299619

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

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.