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Cost implications of HIV retesting for verification in Africa

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  • Arielle Lasry
  • Mireille B Kalou
  • Paul R Young
  • Jacqueline Rurangirwa
  • Bharat Parekh
  • Stephanie Behel

Abstract

Introduction: HIV misdiagnosis leads to severe individual and public health consequences. Retesting for verification of all HIV-positive cases prior to antiretroviral therapy initiation can reduce HIV misdiagnosis, yet this practice has not been not widely implemented. Methods: We evaluated and compared the cost of retesting for verification of HIV seropositivity (retesting) to the cost of antiretroviral treatment (ART) for misdiagnosed cases in the absence of retesting (no retesting), from the perspective of the health care system. We estimated the number of misdiagnosed cases based on a review of misdiagnosis rates, and the number of positives persons needing ART initiation by 2020. We presented the total and per person costs of retesting as compared to no retesting, over a ten-year horizon, across 50 countries in Africa grouped by income level. We conducted univariate sensitivity analysis on all model input parameters, and threshold analysis to evaluate the parameter values where the total costs of retesting and the costs no retesting are equivalent. Cost data were adjusted to 2017 United States Dollars. Results and discussion: The estimated number of misdiagnoses, in the absence of retesting was 156,117, 52,720 and 29,884 for lower-income countries (LICs), lower-middle income countries (LMICs), and upper middle-income countries (UMICs), respectively, totaling 240,463 for Africa. Under the retesting scenario, costs per person initially diagnosed were: $40, $21, and $42, for LICs, LMICs, and UMICs, respectively. When retesting for verification is implemented, the savings in unnecessary ART were $125, $43, and $75 per person initially diagnosed, for LICs, LMICs, and UMICs, respectively. Over the ten-year horizon, the total costs under the retesting scenario, over all country income levels, was $475 million, and was $1.192 billion under the no retesting scenario, representing total estimated savings of $717 million in HIV treatment costs averted. Conclusions: Results show that to reduce HIV misdiagnosis, countries in Africa should implement the WHO’s recommendation of retesting for verification prior to ART initiation, as part of a comprehensive quality assurance program for HIV testing services.

Suggested Citation

  • Arielle Lasry & Mireille B Kalou & Paul R Young & Jacqueline Rurangirwa & Bharat Parekh & Stephanie Behel, 2019. "Cost implications of HIV retesting for verification in Africa," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-15, July.
  • Handle: RePEc:plo:pone00:0218936
    DOI: 10.1371/journal.pone.0218936
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    1. Monisha Sharma & Roger Ying & Gillian Tarr & Ruanne Barnabas, 2015. "Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa," Nature, Nature, vol. 528(7580), pages 77-85, December.
    2. Hanani Tabana & Lungiswa Nkonki & Charles Hongoro & Tanya Doherty & Anna Mia Ekström & Reshma Naik & Wanga Zembe-Mkabile & Debra Jackson & Anna Thorson, 2015. "A Cost-Effectiveness Analysis of a Home-Based HIV Counselling and Testing Intervention versus the Standard (Facility Based) HIV Testing Strategy in Rural South Africa," PLOS ONE, Public Library of Science, vol. 10(8), pages 1-13, August.
    3. Derryck B Klarkowski & Joseph M Wazome & Kamalini M Lokuge & Leslie Shanks & Clair F Mills & Daniel P O'Brien, 2009. "The Evaluation of a Rapid In Situ HIV Confirmation Test in a Programme with a High Failure Rate of the WHO HIV Two-Test Diagnostic Algorithm," PLOS ONE, Public Library of Science, vol. 4(2), pages 1-6, February.
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