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Optimal timing of HIV home-based counselling and testing rounds in Western Kenya

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Title: Optimal timing of HIV home-based counselling and testing rounds in Western Kenya
Authors: Olney, JJ
Eaton, J
Braitstein, P
Hogan, J
Hallett, T
Item Type: Journal Article
Abstract: Introduction: Weaknesses in care programmes providing anti‐retroviral therapy (ART) persist and are often instigated by late HIV diagnosis and poor linkage to care. We investigated the potential for a home‐based counselling and testing (HBCT) campaign to be improved through the optimal timing and enhancement of testing rounds to generate greater health outcomes at minimum cost. Methods: Using a mathematical model of HIV care calibrated to longitudinal data from The Academic Model Providing Access To Healthcare (AMPATH) in Kenya, we simulated HBCT campaigns between 2016 and 2036, assessing the impact and total cost of care for each, for a further 20 years. Results: We find that simulating five equally spaced rounds averts 1.53 million disability‐adjusted life‐years (DALYs) at a cost of $1617 million. By altering the timing of HBCT rounds, a four‐round campaign can produce greater impact for lower cost. With “front‐loaded” rounds, the cost per DALY averted is reduced by 12% as fewer rounds are required ($937 vs. $1060). Furthermore, improvements to HBCT coverage and linkage to care avert over two million DALYs at a cost per DALY averted of $621 (41% less than the reference scenario). Conclusions: Countries implementing HBCT can reduce costs by optimally timing rounds and generate greater health outcomes through improving linkage, coverage, and retention. Tailoring HBCT campaigns to individual settings can enhance patient outcomes for minimal cost.
Issue Date: 8-Jun-2018
Date of Acceptance: 22-May-2018
URI: http://hdl.handle.net/10044/1/60252
DOI: https://dx.doi.org/10.1002/jia2.25142
ISSN: 1758-2652
Publisher: International AIDS Society
Journal / Book Title: Journal of the International AIDS Society
Volume: 21
Issue: 6
Copyright Statement: © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Bill & Melinda Gates Foundation
Funder's Grant Number: OPP1084364
Keywords: HIV
HIV testing
antiretroviral therapy
care cascade
home-based counselling & testing
mathematical model
treatment cascade
1199 Other Medical And Health Sciences
Publication Status: Published
Open Access location: http://dx.doi.org/10.1002/jia2.25142
Article Number: e25142
Appears in Collections:Imperial College Business School
School of Public Health