20162026 Background Population almost 16 million PLWHA 13 million 135 adult prevalence 980 000 on ART virally suppressed 790 000 HIV prevalence in key pops Sex workers 571 Prisoners MSM 28 ID: 755698
Download Presentation The PPT/PDF document "Evaluating the cost-effectiveness of the..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Evaluating the cost-effectiveness of the test and treat program in Zimbabwe
2016-2026Slide2
Background
Population almost 16 million
PLWHA 1.3 million
13.5% adult prevalence
980 000 on ART
# virally suppressed 790 000
HIV prevalence in key pops
Sex workers 57.1%
Prisoners (MSM) 28%Slide3Slide4
Source: National AIDS CouncilSlide5Slide6
Decline in MTCT rate
Source: Big WinSlide7
Factors fueling the spread of HIV
H
igh prevalence of STIs
Low levels of male circumcision
High rates of multiple concurrent sexual relationships
Incorrect or inconsistent condom use
Low socio-economic status of women
Distressed economic conditions ,population mobility and settlement patternsSlide8
Factors which contributed to the decline
Implementation of the Zimbabwe National HIV/AIDS strategic plan which declared HIV a national emergency in 1999
Enactment of the National AIDS Council by an act of parliament
Introduction of 3% AIDS levy on all taxable income in all sectors.
A multi-sectoral approach
Gender sensitive approachSlide9
Ctd…..
Meaningful involvement of PLWHA
Well packaged and targeted interventions for high risk groups
Robust BCC
programme
leading to a massive cultural shift in sexual
behaviour
Rapid scaling up of PMTCT servicesSlide10
Methodology
Goals model a dynamic compartmental model
Simulates transmission trends in adults aged 15-49 in these risks categories
injecting drug users (IDU
)
MSM
female
sex workers and their
clients
multiple
partners
Couples
Study period:
2016-2026
3% discount rate Slide11
Sexual Mixing
11
Males
Stable couple
Females
Stable couple
Males
Non-regular partners
Females
Non-regular partners
Males
SW clients
Females
Sex workers
Males
PWID
Females
PWID
Males
MSM
SPECTRUMSlide12
Determinants of risk of infection
Susceptible Partner
Infected Partner
Number of partners
Male circumcision
Oral
PrEP
Topical
PrEP
Vaccination
HIV infection
Stage of infection
ART
Vaccination
Number of acts per partner
STI prevalence
Heterosexual, MSM, IDU contact
Condom use
SPECTRUMSlide13
Probability of Sexual Transmission
Vaccine
ART
PrEP
use
Condom use Acts/partner Partners/
yr
Male circumcision
STI prevalence
Stage of infection
Probability of transmission per act by sex and type of sex
Prevalence in partner
Where: MC, C,
Pr
, A, V = 1 – effectiveness x coverage
{1 – [P
s’,
g,t
x (1 -
r
s
x
R
g,t
x
S
g,t
x
MC
g,t
x
C
g,t
x
Prg,t
x Ag,t x Vg,t)
a + (1 – Ps’,g,t)]n
}
SPECTRUMSlide14
Data Sources
Category
of Data
Source
Population size
DemProj
, UN Population Division
HIV program
data (ART, PMTCT)
AIM
Epidemic dynamics
(progression, mortality)
AIM
BY
RISK GROUP
Population
size
Surveys, population
size studies (e.g., RDS)
Global reviews:
Aceijas
, Caceres,
Carael
,
Dagenhardt
, Van de
Pitte
Condom useDHS/AIS,
Key population surveys (e.g., IBBS)Number of partnersKey population surveysActs per partner
Key population surveys, global defaultsPercentage ‘married’SurveysIncreased recruitment
Prevalence patternsSTI prevalenceSurveillance, studiesPWID:
Proportion sharing needlesPWID surveysAge at first sex
Demographic surveys
SPECTRUMSlide15Slide16
Scenario analysis
A comparison of CD4 <500
cells per
µL(Constant Coverage) and universal test and treat (UTT) using the following metrics;
QALY
ICER
orphan
years are averted per year
New HIV infections averted
AIDS related deaths prevented Slide17
Key findingsSlide18
AIDS deaths averted Slide19
Key findings
the
UTT
program cost $11.2 billion and $13.2 billion with discount and without discount, respectively.
Under constant coverage the ART program
cost
$7.8
billion and
$8.9
billion with discount and without discount, respectively.
Between
0.45 and 0.61 orphan years are averted per year that an adult
survives
the cost of orphan care averted was $324 per every orphan year.
14.2
million life years
saved
13852.8 QALYs saved
432
125(31%)
new infections averted
39% AIDS death prevented
ICER of $3 871.91 of UTT over
c
onstant coverage Slide20
ICER sensitive to ARV costs and incidence Slide21
Discussions points
UTT has huge fiscal implications upon Zimbabwe
Possible challenges with defaulters and challenges with accessing second line of ART
Some similar studies have showed that ART scale up might not be as effective in the long term
UTT based its conclusions on RCT of which real life scenario might offer a different
result
Need for right mix of prevention interventions
-PrEP cost effective for key population
Need to watch form unintended consensus for some interventions
eg
sex workers reported circumcised men
increased STIs due to
PrEPSlide22
Conclusion
UTT is a good investment opportunity for Zimbabwe as it shows big cost saving opportunity, prevention of new infections, increases in life span and quality of PLWHA
.
Combined with right mix of prevention strategies, country specific test and treat programs might even be more effective