ArticleThe Lancet. Global health2025
Clinical impact and cost-effectiveness of the WHO-recommended advanced HIV disease package of care.
Article in The Lancet. Global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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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
3 citing papers in PubMed.
- Clinical Impact and Cost-Effectiveness of Improving Access to Cryptococcal Meningitis Diagnostics and Treatment in Malawi.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Review
- Cost concentration and resource-use intensity in high-cost HIV/AIDS hospitalizations: evidence from a tertiary infectious disease hospital cohort in China.Frontiers in public health · 2026Article
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Authors and funding
19 authors.
Funding
Abstract
backgroundIn sub-Saharan Africa, 20-40% of people living with HIV present with advanced HIV disease (AHD), which can be diagnosed, treated, and prevented using a package of care recommended by WHO. We aimed to project the cost-effectiveness and budget impact of the WHO-recommended AHD package in Malawi.
methodsUsing the Cost-Effectiveness of Preventing AIDS Complications-International model, we simulated a cohort of non-hospitalised people living with HIV (aged >19 years) initiating antiretroviral therapy (ART), 25% of whom had AHD (CD4 count <200 cells per μL and/or WHO stage 3 or 4 disease). We assessed 13 increasingly comprehensive strategies, ranging from ART only to the WHO-recommended AHD package, including tuberculosis diagnostics (ie, sputum Xpert and urine lipoarabinomannan), tuberculosis preventive therapy, serum cryptococcal antigen (CrAg) screening with pre-emptive fluconazole treatment if CrAg-positive, and co-trimoxazole to prevent bacterial infections. Model outcomes included 1 year survival, life expectancy, costs, and incremental cost-effectiveness ratios (ICERs, US$ per quality-adjusted life-year [QALY]); we considered a strategy cost-effective if the ICER was less than $600 per QALY (based on 2023 Malawi per capita gross domestic product).
findingsART only resulted in life expectancy of 17·45 undiscounted QALYs and discounted lifetime costs of $1450. All other strategies would increase both QALYs and costs. The WHO-recommended AHD package would result in the greatest life expectancy (19·30 undiscounted QALYs) and be cost-effective (ICER $580 per QALY). AHD prevalence and intervention efficacy had the greatest influence on ICERs; however, the WHO-recommended AHD package would remain cost-effective over a wide range of estimates.
interpretationThe WHO-recommended AHD package of care at ART initiation would provide substantial clinical benefits and be cost-effective in Malawi. This package for AHD should be made widely available in Malawi and similar settings.
fundingWHO, the HIV Modelling Consortium within the Institute for Global Health at University College London, the Bill & Melinda Gates Foundation, the National Institute of Allergy and Infectious Diseases, the Massachusetts General Hospital Jerome and Celia Reich Endowed Scholar in HIV/AIDS Research Award, and the Steve and Deborah Gorlin Massachusetts General Hospital Research Scholars Award. TRANSLATION: For the Chichewa translation of the abstract see Supplementary Materials section.
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