Better Retention in Care is a Cost-Effective Way to Improve Outcomes in HIV Disease
Boston, MA – For more than 20 million people infected with the human immunodeficiency virus (HIV) in Africa, treatment with antiretroviral therapy (ART) can suppress the virus and stop progression of the disease, leading to substantial reduction in suffering and rates of death. However, the effectiveness of ART is undermined by the large number of individuals who initiate treatment but do not continue regular clinic visits and taking medication. Strategies to improve retention in care may improve long-term outcomes, but concerns of prohibitive costs serve as barriers to implementing such programs. In an article published in the October 26, 2009 issue of PLoS Medicine, researchers from the US, France and Côte-d’Ivoire, West Africa collaborated using a validated computer simulation model of HIV disease (CEPAC-International) to evaluate the cost-effectiveness of potential strategies designed to prevent loss from HIV care.
Major international efforts have increased ART availability, but it is critical to ensure that HIV-infected patients in African countries, like Côte d’Ivoire, who initiate ART, receive regular follow-up and continue taking these life-saving medicines. “Starting ART without appropriate long-term care is not enough to ensure the full benefit of treatment. Survival losses from stopping care within one year since starting ART range from 74 to 81 months,” explains Elena Losina, PhD, a researcher at Brigham and Women’s Hospital (BWH), and lead author of the study. Loss to follow-up creates a challenge for the success of expanding ART programs.
To address the issue of preventing loss-to-follow-up, the researchers used a model to assess the cost-effectiveness of interventions addressing this issue. The interventions considered included reducing costs to patients by eliminating medication co-payments, paying for transportation, increasing services to patients by improving staff training, and providing meals. The researchers found that at a per person cost of $22 to $77 per year, if these strategies were even modestly effective, they would be highly cost-effective by World Health Organization (WHO) standards.
“These results demonstrate that in resource-limited settings, loss to follow-up prevention strategies would improve survival, be cost-effective, and should be incorporated into HIV treatment programs to improve patient outcomes,” said Dr. Xavier Anglaret, director of the PAC-CI HIV program in Abidjan, Côte d’Ivoire, and co-investigator on the study. “The next step is to test these different interventions, and determine which are the most effective.”
The study was conducted within collaboration of ART-LINC Collaboration of International Epidemiological Databases to Evaluate AIDS (IeDEA) and the CEPAC International Research Team. Co-authors include Hapsa Toure, Xavier Anglaret, Eric Baleste, Francois Dabis from INSERM U897, Institut de Sante´ Publique d’Epide´miologie et de De´veloppement (ISPED), Universite Victor Segalen, Bordeaux, Lauren Uhler, Rochelle P. Walensky, Kenneth A. Freedberg from Massachusetts General Hospital, A. David Paltiel from Yale University, Eugene Messou from CePReF, Abidjan, Cote d’Ivoire, Milton C. Weinstein, PhD from Harvard School of Public Health.
The study was funded by the National Institute of Allergy and Infectious Diseases and the French Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS).
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