Economic and epidemiological impact of early antiretroviral therapy initiation in India

Research output: Contribution to journalArticle

Abstract

Introduction: Recent WHO guidance advocates for early antiretroviral therapy (ART) initiation at higher CD4 counts to improve survival and reduce HIV transmission. We sought to quantify how the cost-effectiveness and epidemiological impact of early ART strategies in India are affected by attrition throughout the HIV care continuum. Methods: We constructed a dynamic compartmental model replicating HIV transmission, disease progression and health system engagement among Indian adults. Our model of the Indian HIV epidemic compared implementation of early ART initiation (i.e. initiation above CD4≥350 cells/mm3) with delayed initiation at CD4 ≤350 cells/mm3; primary outcomes were incident cases, deaths, quality-adjusted-life-years (QALYs) and costs over 20 years. We assessed how costs and effects of early ART initiation were impacted by suboptimal engagement at each stage in the HIV care continuum. Results: Assuming "idealistic" engagement in HIV care, early ART initiation is highly cost-effective ($442/QALY-gained) compared to delayed initiation at CD4≤350 cells/mm3 and could reduce new HIV infections to

Original languageEnglish (US)
Article number20217
JournalJournal of the International AIDS Society
Volume18
Issue number1
DOIs
StatePublished - Oct 1 2015

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Secondary Prevention
India
Economics
HIV
Continuity of Patient Care
Quality-Adjusted Life Years
Costs and Cost Analysis
CD4 Lymphocyte Count
HIV Infections
Cost-Benefit Analysis
Disease Progression
Health

Keywords

  • Antiretroviral therapy
  • Continuum of care
  • Cost-effectiveness
  • HIV
  • India

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health

Cite this

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