dc.contributor.author | Culhane, Jessica | |
dc.contributor.author | Sharma, Monisha | |
dc.contributor.author | Wilson, Kate | |
dc.contributor.author | Roberts, Allen | |
dc.contributor.author | Mugo, Cyrus | |
dc.contributor.author | Wamalwa, Dalton | |
dc.contributor.author | Inwani, Irene | |
dc.contributor.author | Barnabas, Ruanne V | |
dc.contributor.author | Kohler, Pamela K | |
dc.date.accessioned | 2020-11-04T09:00:48Z | |
dc.date.available | 2020-11-04T09:00:48Z | |
dc.date.issued | 2020 | |
dc.identifier.citation | Culhane J, Sharma M, Wilson K, Roberts DA, Mugo C, Wamalwa D, Inwani I, Barnabas RV, Kohler PK. Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya. EClinicalMedicine. 2020 Jul 16;25:100453. doi: 10.1016/j.eclinm.2020.100453. PMID: 32954235; PMCID: PMC7486332. | en_US |
dc.identifier.uri | https://pubmed.ncbi.nlm.nih.gov/32954235/ | |
dc.identifier.uri | http://erepository.uonbi.ac.ke/handle/11295/153309 | |
dc.description.abstract | Background: Despite high efficacy of oral antiretroviral therapy (ART), viral suppression among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA) remains low. Compared to daily oral ART, bimonthly long-acting injectable ART (LA-ART) may simplify adherence, improve clinical outcomes, and decrease HIV transmission in this priority population. However, LA-ART will likely cost more than oral ART and the cost threshold at which LA-ART will be cost effective in SSA has not been evaluated.
Methods: We adapted a mathematical model of HIV transmission and progression in Kenya to include HIV acquisition and viral suppression among AYA (age 10-24). We projected the population-level health and economic impact of providing LA-ART to AYA over a 10-year time horizon assuming oral ART costs of US$233 annually and a two-month duration of viral suppression per LA-ART injection. We calculated the maximum cost at which switching from oral to LA-ART would be considered cost-effective, using thresholds of $500 and $1,508 per disability-adjusted life year averted (WHO's threshold of HIV treatment interventions and Kenya's gross domestic product per capita).
Findings: Assuming 85% of AYA switch from oral to injectable formulations, LA-ART is estimated to prevent 40,540 infections and 20,480 deaths over 10 years. The maximum increase in the annual per-person cost of receiving LA-ART is estimated to be $89 and $236 for LA-ART to be cost-effective under the thresholds of $500 and $1,508 per DALY averted, respectively. The cost threshold was lower when non-adherent oral ART AYA users were assumed to be less likely to switch to LA-ART.
Interpretation: Providing LA-ART to AYA can be cost-effective in Kenya if it is less than twice the cost of oral ART. Long-acting injectable ART for priority populations with low viral suppression has the potential to cost-effectively avert disability and death.
Funding: National Institutes of Health (R01 HD085807; PI: Kohler). | en_US |
dc.language.iso | en | en_US |
dc.publisher | University of Nairobi | en_US |
dc.rights | Attribution-NonCommercial-NoDerivs 3.0 United States | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/us/ | * |
dc.subject | Adolescent; Cost-effectiveness; Kenya; Long-acting ART; Modeling; Young adult. | en_US |
dc.title | Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya | en_US |
dc.type | Article | en_US |