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dc.contributor.authorLosina, Elenaen_US
dc.contributor.authorTouré, Hapsatouen_US
dc.contributor.authorUhler, Lauren M.en_US
dc.contributor.authorAnglaret, Xavieren_US
dc.contributor.authorPaltiel, A. Daviden_US
dc.contributor.authorBalestre, Ericen_US
dc.contributor.authorWalensky, Rochelle P.en_US
dc.contributor.authorMessou, Eugèneen_US
dc.contributor.authorWeinstein, Milton C.en_US
dc.contributor.authorDabis, Françoisen_US
dc.contributor.authorFreedberg, Kenneth A.en_US
dc.date.accessioned2012-01-11T16:09:05Z
dc.date.available2012-01-11T16:09:05Z
dc.date.issued2009-10-27
dc.identifier.citationLosina, Elena, Hapsatou Touré, Lauren M. Uhler, Xavier Anglaret, A. David Paltiel, Eric Balestre, Rochelle P. Walensky, Eugène Messou, Milton C. Weinstein, François Dabis, Kenneth A. Freedberg. "Cost-Effectiveness of Preventing Loss to Follow-up in HIV Treatment Programs: A Côte d'Ivoire Appraisal" PLoS Medicine 6(10):e1000173. (2009)
dc.identifier.issn1549-1676
dc.identifier.urihttps://hdl.handle.net/2144/3102
dc.description.abstractBased on data from West Africa, Elena Losina and colleagues predict that interventions to reduce dropout rates from HIV treatment programs (such as eliminating copayments) will be cost-effective. BACKGROUND. Data from HIV treatment programs in resource-limited settings show extensive rates of loss to follow-up (LTFU) ranging from 5% to 40% within 6 mo of antiretroviral therapy (ART) initiation. Our objective was to project the clinical impact and cost-effectiveness of interventions to prevent LTFU from HIV care in West Africa. METHODS AND FINDINGS. We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model to project the clinical benefits and cost-effectiveness of LTFU-prevention programs from a payer perspective. These programs include components such as eliminating ART co-payments, eliminating charges to patients for opportunistic infection-related drugs, improving personnel training, and providing meals and reimbursing for transportation for participants. The efficacies and costs of these interventions were extensively varied in sensitivity analyses. We used World Health Organization criteria of >3× gross domestic product per capita (3× GDP per capita = US$2,823 for Côte d'Ivoire) as a plausible threshold for "cost-effectiveness." The main results are based on a reported 18% 1-y LTFU rate. With full retention in care, projected per-person discounted life expectancy starting from age 37 y was 144.7 mo (12.1 y). Survival losses from LTFU within 1 y of ART initiation ranged from 73.9 to 80.7 mo. The intervention costing US$22/person/year (e.g., eliminating ART co-payment) would be cost-effective with an efficacy of at least 12%. An intervention costing US$77/person/year (inclusive of all the components described above) would be cost-effective with an efficacy of at least 41%. CONCLUSIONS. Interventions that prevent LTFU in resource-limited settings would substantially improve survival and would be cost-effective by international criteria with efficacy of at least 12%–41%, depending on the cost of intervention, based on a reported 18% cumulative incidence of LTFU at 1 y after ART initiation. The commitment to start ART and treat HIV in these settings should include interventions to prevent LTFU.en_US
dc.description.sponsorshipUS National Institute of Allergy and Infectious Diseases (R01 AI058736, K24 AI062476, P30 AI 060354); Harvard University Center for AIDS Research (5U01AI069919); French Agence Nationale de Recherches sur le SIDA et les hépatites (ANRS 12 138 ART-LINC LTFU); National Institues of Health; the National Cancer Institute; the Eunice Kennedy Shriver National Institute of Child Health & Human Development; Doris Duke Charitable Foundation; Clinical Scientist Development Awarden_US
dc.language.isoen
dc.publisherPublic Library of Scienceen_US
dc.rightsCopyright Losina et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_US
dc.titleCost-Effectiveness of Preventing Loss to Follow-up in HIV Treatment Programs: A Côte d'Ivoire Appraisalen_US
dc.typeArticleen_US
dc.identifier.doi10.1371/journal.pmed.1000173
dc.identifier.pmid19859538
dc.identifier.pmcid2762030


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