ArticleEClinicalMedicine2020
Cost-effectiveness analysis of pre-ART HIV drug resistance testing in Kenyan women.
Article in EClinicalMedicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 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
- Prevalence of acquired and transmitted HIV drug resistance in Iran: a systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- Oligonucleotide Ligation Assay (OLA)-Simple: Field Implementation, Usability, and Performance of a near Point-of-Care HIV Drug Resistance Assay in Kenya.Laboratories · 2026Article
- Modeling the potential impact of viral load monitoring on vertical transmission of HIV in Kenya.AIDS (London, England) · 2025Article
- Cost-effectiveness of pretreatment HIV drug resistance testing in people living with HIV in Iran.PloS one · 2024Article
- Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study.BMC health services research · 2022Article
- 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
- Pre-treatment HIV drug resistance testing cost-effectiveness.EClinicalMedicine · 2020Article
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundThe prevalence of pre-treatment drug resistance (PDR) to non-nucleoside reverse-transcriptase inhibitor (NNRTI) agents is increasing in sub-Saharan Africa, which may decrease the effectiveness of efavirenz-based antiretroviral therapy (ART) programs. However, due to recent safety concerns, there has been hesitancy to replace efavirenz-based ART with dolutegravir in women of reproductive potential. Our objective was to evaluate whether PDR testing for women not initiating dolutegravir-based ART would be a cost-effective strategy to address the challenges posed by PDR.
methodsWe developed an HIV drug resistance model that simulates the emergence and transmission of resistance mutations, calibrated to the Kenyan epidemic. We modeled three care strategies for PDR testing among women not initiating dolutegravir-based ART: no PDR testing, PDR testing with a low-cost point mutation assay, known as oligonucleotide ligation assay (OLA), and PDR testing with consensus sequencing. Using a health sector perspective, this model was used to evaluate the health outcomes, lifetime costs, and cost-effectiveness under each strategy over a 15-year time horizon starting in 2019.
findingsOLA and CS PDR testing were projected to have incremental cost-effectiveness ratios (ICER) of $10,741/QALY gained and $134,396/QALY gained, respectively, which are not cost-effective by national income standards. Viral suppression rates among women at 12 months after ART initiation were 87·8%, 89·0%, and 89·3% with no testing, OLA testing, and CS testing, respectively. PDR testing with OLA and CS were associated with a 0.5% and 0.6% reduction in incidence rate compared to no PDR testing. Initial PDR prevalence among women was 13.1% in 2019. By 2034, this prevalence was 17·6%, 17·4%, and 17·3% with no testing, OLA testing, and CS testing, respectively.
interpretationPDR testing for women is unlikely to be cost-effective in Kenya whether one uses a low-cost assay, such as OLA, or consensus sequencing.
fundingNational Institutes of Health, Gilead Sciences.
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