Cost savings associated with the provision of a simple care package including long lasting insecticide treated bednets and a point-of-use water filtration device to delay HIV-1 disease progression in Africa
Background: Despite incredible advances in antiretroviral
therapy (ART) scale-up in sub-Saharan (SSA), sustained funding for HIV-1
treatment is insecure. A recent trial in Kenya found that the provision of long-lasting
insecticide-treated bednet (LLIN) and water filter to HIV-1 infected adults not
yet eligible for ART resulted in a 27% delay in the time to CD4 ≤ 350
cells/mm3 (HR 0.73
(95% CI: 0.57-0.95); p=0.017) and a significant reduction in CD4 decline
(-54 vs. -70 cells/mm3/year) after two years. We estimated the HIV-1
related cost-effectiveness of an intervention distributing LLIN and water
filter to ART ineligible HIV-1 infected adults in SSA.
Methods: We used a mathematical
epidemiological-cost model using SSA data. The intervention targeted HIV-1
seropositive adults aware of their HIV-1 status (40% of people not eligible for
ART) in SSA. Intervention and ART costs were $22 per person and $700 per person-year,
respectively. HIV-1 related benefits were estimated two years after the
intervention. Cost savings related to ART initiation delay were estimated for the
first year of ART. The model did not incorporate health benefits attributable
to the potential prevention of malaria and diarrhea.
Results: The intervention would cost $100
million and would result in treatment-related cost savings of $402 million, or
about 8% of the annual PEPFAR HIV care and treatment budget ($4.9 billion). The
intervention would save 2,040,000 years-of-life off ART and prevent 31,000 deaths within 2 years. We continued to document overall cost savings
until ART costs reached $173 per year or effectiveness in delaying time to ART
Conclusions: The provision of LLIN and water
filter to HIV-1 infected adults awaiting ART initiation is cost-effective and can
substantially impact current HIV-1 care and treatment budgets, largely by
reducing ART costs. Expanding coverage to infected adults not yet knowing their
HIV-1 serostatus would dramatically increase the benefits documented.
19th International AIDS Conference
"S.Verguet, et al.
Cost savings associated with the provision of a simple care package including long lasting insecticide treated bednets and a point-of-use water filtration device to delay HIV-1 disease progression in Africa.
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