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The most efficient use of resources to identify those in need of antiretroviral treatment in Africa: empirical data from Côte d'Ivoire's Drug Access Initiative

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dc.contributor.author Diomandé, F. V. K. en_US
dc.contributor.author Bissagnéné, E. en_US
dc.contributor.author Nkengasong, J. N. en_US
dc.contributor.author Maurice, C. en_US
dc.contributor.author Monga, B. en_US
dc.contributor.author Laga, M. en_US
dc.contributor.author Nolan, M. L. en_US
dc.date.accessioned 2007-12-06T14:46:53Z
dc.date.available 2007-12-06T14:46:53Z
dc.date.issued 2003 en_US
dc.identifier.issn 0269-9370 en_US
dc.identifier.other ITG-NOT en_US
dc.identifier.other ITG-N6M en_US
dc.identifier.other MICRO en_US
dc.identifier.other U-HIVSTD en_US
dc.identifier.other JIF en_US
dc.identifier.other ABSTRACT en_US
dc.identifier.uri http://hdl.handle.net/10390/1745
dc.description Not the final published version
dc.description.abstract OBJECTIVE: To describe the cost and outcome associated with the use of CD4 cell count and viral load tests as part of screening strategies to identify persons eligible for subsidized antiretroviral therapy (ART) in Côte d'Ivoire. METHODS: Empirical data from the Drug Access Initiative in Côte d'Ivoire (DAI-CI) were used to describe the laboratory cost of patient screening using sequential clinical staging, CD4 cell count, and viral load and the proportion of screened patients identified as eligible for ART. We also estimated costs modelling a parallel screening algorithm, across a range of laboratory costs and with current international recommendations to assess treatment eligibility. Benefit was defined as being found eligible for ART. RESULTS: Of the 2138 HIV-positive, ART-naive, adults who presented to the DAI-CI between July 1998 and July 2000, median CD4 cell count was 172 x 10(6) cells/microl. DAI-CI criteria identified 2057 (96%) of these persons eligible for antiretroviral treatment. In a serial screening algorithm, 75% were eligible by CDC clinical stage B or C; 18% by CD4 cell count less than 500 x 10(6) cells/microl; and an estimated 3.9% by a viral load greater than 10 000 copies/ml. Use of the current US recommendations and a serial algorithm would have resulted in 1977 (92%) persons eligible for ART: 75% by CDC clinical stage B or C; 15% by CD4 cell count less than 350 x 10(6) cells/microl (including 8% < 200 x 10(6) cells/microl); and an estimated 3.6% due to viral load greater than 55 000 copies/ml. Using DAI-CI criteria and heavily subsidized laboratory test costs, the addition of CD4 cell count to clinical criteria cost US dollar 50 (serial algorithm) and US dollar 203 (parallel algorithm) to identify each additional eligible person. Modelling current recommendations with a serial algorithm, CD4 cell count cost an average US dollar 62/eligible person (US recommendations) and US dollar 109 (WHO recommendations). The addition of viral load cost between US dollar 108 (serial algorithm DAI) to US dollar 1700 (parallel algorithm DAI) to identify each additional eligible person. CONCLUSION: In the African context of scarce resources and the huge unmet demands for voluntary HIV testing and for ART, simple screening strategies are needed to identify those most in need of ART. Health personnel should be trained to identify and refer clinically symptomatic persons. Viral load testing is of high cost and dubious benefit and should not be part of screening algorithms for initiating ART. en_US
dc.language English en_US
dc.publisher Lippincott, Williams & Wilkins
dc.subject Viral diseases en_US
dc.subject HIV en_US
dc.subject AIDS en_US
dc.subject Antiretrovirals en_US
dc.subject HAART en_US
dc.subject Voluntary counseling and testing (VCT) en_US
dc.subject Resource allocation en_US
dc.subject Targeting en_US
dc.subject Screening en_US
dc.subject Viral load en_US
dc.subject CD4 lymphocyte count en_US
dc.subject Cost-effectiveness en_US
dc.subject Côte d'Ivoire en_US
dc.subject Africa, West en_US
dc.title The most efficient use of resources to identify those in need of antiretroviral treatment in Africa: empirical data from Côte d'Ivoire's Drug Access Initiative en_US
dc.type Article en_US
dc.citation.issue Suppl.3 en_US
dc.citation.jtitle AIDS en_US
dc.citation.volume 17 en_US
dc.citation.pages S87-S93 en_US
dc.publisher.place Philadelphia
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/14565614
dc.citation.jabbreviation AIDS en_US


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