Costs and cost-effectiveness of neonatal HIV early infant diagnosis (EID) versus standard of care EID in Mozambique and Tanzania

Elsbernd, Kira (2024): Costs and cost-effectiveness of neonatal HIV early infant diagnosis (EID) versus standard of care EID in Mozambique and Tanzania. Dissertation, LMU München: Medizinische Fakultät

Abstract

Introduction: Prompt and affordable access to early infant diagnosis (EID) for HIV is critical, especially for neonates acquiring HIV during gestation for whom mortality in the first months of life is high without treatment. Late diagnosis causes delays in access to lifesaving antiretroviral treatment. Point-of-care (PoC) testing at birth offers an opportunity for same-day treatment initiation at the earliest time possible. However, accurate cost data is needed for planning scale-up and assessing sustainability of EID programs. Methods: We estimated the health system cost of birth plus 4–6-week testing (very early infant diagnosis; VEID) compared to standard of care (SoC) HIV testing at 4-6 weeks only, both with immediate linkage to treatment. This cost and cost-effectiveness study was nested within the cluster-randomized LIFE study conducted at 28 primary health facilities and evaluated costs of using the Abbott mPIMATM in Mozambique and Cepheid GeneXpert® in Tanzania for HIV testing. We report empirical costs in the LIFE study and additionally simulate integrated and EID program costs scaled to routine demand for EID. Results: The estimated cost per test in the LIFE study was $39.12 (95% CI: $37.69, $39.99) for VEID versus $40.57 ($40.57, $42.84) for SoC in Mozambique and $36.23 ($34.99, $38.40) for VEID versus $43.88 ($41.12, $45.21) for SoC in Tanzania. Estimated cost per HIV-exposed infant tested and initiated on ART were $85.44 ($84.17, $87.64) for VEID versus $37.05 ($36.47, $38.51) for SoC in Mozambique and $68.34 ($67.15, $71.99) for VEID versus $37.38 ($35.31, $38.82) for SoC in Tanzania. Neonates tested at birth started ART at median 0.86 weeks of age compared to 4.71 weeks of age receiving SoC procedures (p<0.0001). Scaling costs to current routine demand for EID reduced the test cost by up to 28% in Mozambique and up to 14% in Tanzania. Utilization of PoC platforms varied across time and health facility, with many sites exhibiting potential to increase efficiency and reduce equipment costs by increasing utilization. Conclusion: Birth testing is more expensive but results in more frequent and significantly earlier ART initiation. When considering placement of limited PoC analyzers and scale-up of EID programs, alternative solutions that increase efficiency of PoC analyzers such as multiplexing for cost-sharing across programs or increasing access to PoC testing through hub-and-spoke service delivery should be explored.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: early infant diagnosis, point-of-care, birth testing, micro-costing, cost-effectiveness
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 6. Dezember 2024
• 1. Bericht­erstatter:in: Hölscher, Michael