XIX International AIDS Conference


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MOPE768 - Poster Exhibition

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

S. Verguet1, D. Jamison1, B. Singa2, J. Naulikha2,3, B. Piper1,2, K. Yuhas4, L. Sangaré1, P. Otieno2, B. Richardson5,6, G. John-Stewart7, J. Walson2,7

1University of Washington, Global Health, Seattle, United States, 2Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya, 3University of Washington, Pediatrics, Seattle, United States, 4University of Washington, Seattle, United States, 5University of Washington, Biostatistics, Global Health, Seattle, United States, 6Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, United States, 7University of Washington, Global Health, Medicine, Pediatrics, Epidemiology, Seattle, United States

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 reached 6%.
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.

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