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Missed opportunities to accessing HIV testing and antiretroviral therapy during routine patient-provider encounters in Sub-Saharan Africa: a systematic review of the evidence

January 2011
Tropical Medicine & International Health 16

Authors:

Maria Roura

University College Cork

Deborah Watson-Jones

London School of Hygiene and Tropical Medicine

Laura Ferguson

University of Southern California

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Cost-effectiveness of community-based HIV self-testing in Blantyre, Malawi

November 2017 · Clinical Infectious Diseases

Background: HIV self-testing (HIVST) is effective, with scale-up underway in sub-Saharan Africa. We assessed cost-effectiveness of adding HIVST to existing facility-based HIV testing and counselling (HTC) services. Both 2010 (initiate at CD4<350 cells/μl) and 2015 (initiate all) WHO guidelines for antiretroviral treatment (ART) were considered. Methods: A microsimulation model was developed ... [Show full abstract] that evaluated cost-effectiveness, from both health provider and societal perspectives, of an HIVST service implemented in a cluster-randomised trial (CRT) (ISRCTN02004005) in Malawi. The economic model drew upon health outcomes data observed in the CRT, and primary health economic studies undertaken in the trial population. Costs and health outcomes were evaluated over a 20-year time horizon, using a discount rate of 3%. Probabilistic sensitivity analysis was conducted to account for parameter uncertainty. Results: From the health provider perspective and 20-year time horizon, facility HTC using 2010 WHO ART guidelines was the least costly (US$294.71 per person, 95%CrI:270.79-318.45) and least effective (11.64 QALYs per person, 95%CrI:11.43-11.86) strategy. Compared to this strategy, the incremental cost-effectiveness ratio (ICER) for facility HTC using 2015 WHO ART guidelines was US$226.85 (95%CrI:198.79-284.35) per quality-adjusted life year (QALY) gained. The strategy of facility HTC plus HIVST, using 2010 WHO ART guidelines, was extendedly dominated. The ICER for facility HTC plus HIVST, using 2015 WHO ART guidelines, was US$253.90 (95%CrI:201.71-342.02) per QALY gained compared with facility HTC and using 2015 WHO ART guidelines. Conclusions: HIVST may be cost-effective in a Malawian population with high HIV prevalence. HIVST is suited to an early HIV diagnosis and treatment strategy.

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Employer‐Sponsored Programmes for the Prevention and Treatment of HIV/AIDS: Recent Experience from S...

July 2011 · International Social Security Review

This article examines a sample of employer programmes in sub‐Saharan Africa that supplement government efforts to prevent and treat human immunodeficiency virus (HIV). Some of these programmes provide workers with in‐house education, voluntary HIV testing and antiretroviral treatment. Others rely on new forms of employment‐based group health insurance that include an HIV treatment package. In ... [Show full abstract] addition, some enterprises use the workplace as a platform for launching efforts into neighbouring communities to reach spouses, children, sex workers, secondary school students and others. Early evidence suggests that employer programmes maintain the health of large fractions of workers living with HIV who are served by them. They further enable enterprises to avoid productivity losses and turnover costs associated with HIV. At the same time, they take pressure off government agencies that face demands for treatment far exceeding their capacity. The article identifies features of successful employer programmes including “elite appeal”, which mobilizes community leaders and role models to deconstruct stigma, change perceptions and call for behavioural change; and “collateral linkage”, which extends the reach of HIV workplace programmes by linking them to related community concerns: e.g. alcohol abuse, malaria and domestic violence. Looking forward, the potential for expanding employer programmes as well as the restrictions associated with the limited scale of formal‐sector employment within sub‐Saharan African economies is assessed. Actions by which governments, employer associations, trade unions and international organizations can encourage further development of such programmes and extend their reach are suggested.

Outcome of Tuberculosis Treatment in Tertiary Hospital in South Eastern Nigeria

February 2015

Tuberculosis (TB) is a leading cause of morbidity and mortality rate in developing countries in Asia and sub Saharan Africa. Effective treatment depends on early case detection and patients' adherence to treatment procedures. In many resource-constrained settings, tuberculosis treatment outcome is un-satisfactory. This study determined the outcome of tuberculosis treatment and factors associated ... [Show full abstract] with such outcomes, in a Teaching Hospital where TB Directly Observed Treatment Short-course (DOTS) strategy is adopted. A register-based historical cohort study of patients accessing care at DOTS clinic of the hospital from 1 st January to 31 st December 2012 was conducted. Information on the socio-demographic characteristics of patients, disease site, patient type, result of baseline sputum examination, treatment category, outcome of treatment, consent for HIV testing, result of HIV test and antiretroviral therapy were extracted. Records of 315 registered tuberculosis patients revealed 61.3% successful treatment, 1.9% treatment failure, 16.2% death, 14.6% defaulters, 5.4% transferred-out and 0.6% missing results. Outcome of tuberculosis treatment was significantly associated with gender and HIV status of patients. Majority had successful treatment outcome. Improper record keeping posed problem. Intensification of efforts at control of tuberculosis and HIV counseling and testing and training of records personnel on proper record keeping are recommended.

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Prediction of Clinical Outcomes Amongst Patients with Kaposi's Sarcoma Initially Treated with Antire...

October 2015

Background: HIV‐infected patients with KS who have functionally disabling complications from their KS require urgent chemotherapy to quickly relieve symptoms; treatment with antiretroviral therapy (ART) alone is inadequate. In patients without functionally disabling KS, standard of care is often to initiate ART alone, but, in sub‐Saharan Africa, patients treated in this way have ~20% one‐year ... [Show full abstract] mortality, which is several‐fold higher than those initiating ART without KS. Initial use of chemotherapy in addition to ART might improve outcomes in these patients but its use in all patients with AIDS‐KS in Africa is currently cost‐prohibitive. Thus, establishing which factors, if any, predict poor KS outcomes might help to inform which KS patients without an urgent indication for chemotherapy can be safely started on ART alone versus those who might benefit from other concurrent interventions (e.g., chemotherapy).

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