ArticleEClinicalMedicine2020
Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa.
Article in EClinicalMedicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- A Urine Tenofovir Point-of-Care Assay Facilitates Positive Antiretroviral Therapy Adherence Discussions Among People Living With HIV and Healthcare Providers-A Mixed-Methods Evaluation in Cape Town, South Africa.Journal of the International AIDS Society · 2026Trial
- Cost and clinical flow of point-of-care urine tenofovir testing for treatment monitoring among people living with HIV initiating ART in South Africa.Journal of the International AIDS Society · 2025Trial
- Trial
- Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries.Health affairs scholar · 2026Article
- Cost and impact of decentralized tuberculosis testing: a modeling analysis of price thresholds for molecular instruments in high-burden settings.EClinicalMedicine · 2026Article
- Limited user fees for adult HIV diagnosis and routine laboratory monitoring in the global IeDEA consortium: analysis in 42 countries.medRxiv : the preprint server for health sciences · 2025Article
- Ten-year health impact, economic impact and return on investment of the South African molecular diagnostics programme for HIV, tuberculosis and SARS-CoV-2.BMJ global health · 2024Article
- The potential promise and pitfalls of point-of-care viral load monitoring to expedite HIV treatment decision-making in rural Uganda: a qualitative study.BMC health services research · 2024Article
- Feasibility, Acceptability and Appropriateness of MedViewer: A Novel Hair-Based Antiretroviral Real-Time Clinical Monitoring Tool Providing Adherence Feedback to Patients and Their Providers.AIDS and behavior · 2023Article
- Field performance and cost-effectiveness of a point-of-care triage test for HIV virological failure in Southern Africa.Journal of the International AIDS Society · 2023Article
- The effect of substance uses on antiretroviral treatment adherence in primary health care.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2023Article
- Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study.JMIR formative research · 2022Article
- Optimising courier specimen collection time improves patient access to HIV viral load testing in South Africa.African journal of laboratory medicine · 2022Article
- Costing and cost-effectiveness of Cepheid Xpert HIV -1 Qual Assay using whole blood protocol versus PCR by Abbott Systems in Malawi.Journal of global health economics and policy · 2022Article
- Article
- Costs of Point-of-Care Viral Load Testing for Adults and Children Living with HIV in Kenya.Diagnostics (Basel, Switzerland) · 2021Article
- Bringing Data Analytics to the Design of Optimized Diagnostic Networks in Low- and Middle-Income Countries: Process, Terms and Definitions.Diagnostics (Basel, Switzerland) · 2020Review
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundViral load (VL) testing is recommended for monitoring people on ART. The National Health Laboratory Service (NHLS) in South Africa conducts >5million laboratory-based VL tests but faces challenges with specimen integrity and results delivery. Point-of-care (POC) VL monitoring may improve VL suppression (VLS). We assessed the cost-effectiveness of different strategies for POC testing in South Africa.
methodsWe developed a cost-outcome model utilizing NHLS data, including facility-level annual VL volumes, proportion with VLS, specimen rejection rates, turn-around-time, and the cost/test. We assessed the impact of adopting POC VL technology under 4 strategies: (1) status-quo; (2) targeted POC testing at facilities with high levels of viral failure; (3) targeted POC testing at low-performing facilities; (4) complete POC adoption. For each strategy, we determined the total cost, effectiveness (expected number of virally suppressed people) and incremental cost-effectiveness ratio (ICER) based on expected (>10%) VLS improvement.
findingsExisting laboratory-based VL testing costs $126 m annually and achieves 85.2% VLS. Strategy 2 was the most cost-effective approach, with 88.5% VLS and $40/additional person suppressed, compared to the status-quo. Should resources allow, complete POC adoption may be cost-effective (ICER: $136/additional person suppressed), requiring an additional $49 m annually and achieving 94.5% VLS. All other strategies were dominated in the incremental analysis.
interpretationAssuming POC VL monitoring confers clinical benefits, the most cost-effective strategy for POC adoption in South Africa is a targeted approach with POC VL technologies placed at facilities with high level of viral failure.
fundingFunding support from the Bill & Melinda Gates Foundation.
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