Mathieu Maheu-Giroux1, Souleymane Diabaté2,3, Marie-Claude Boily4, Nedjéda Jean-Paul1, Juan F Vesga4, Stefan Baral5, Kouamé Abo6, Venance Wognin6, Daouda Diouf7, Michel Alary3,8,9. 1. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada. 2. Département de Maladies Infectieuses et Tropicales, Université Alassane Ouattara, Bouaké, Côte d'Ivoire. 3. Centre de Recherche du CHU de Québec, Université Laval, Québec City, Québec, Canada. 4. Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, London, United Kingdom. 5. Department of Epidemiology, Key Populations Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 6. Programme national de lutte contre le Sida, Ministère de la santé et de l'hygiène publique, Abidjan, Côte d'Ivoire. 7. Enda Santé, Dakar, Sénégal. 8. Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada. 9. Institut national de santé publique du Québec, Québec City, Québec, Canada.
Abstract
BACKGROUND: Despite Côte d'Ivoire epidemic being labeled as "generalized," key populations (KPs) are important to overall transmission. Using a dynamic model of HIV transmission, we previously estimated the impact of several treatment-as-prevention strategies that reached-or missed-the UNAIDS 90-90-90 targets in different populations groups, including KP and clients of female sex workers (CFSWs). To inform program planning and resources allocation, we assessed the cost-effectiveness of these scenarios. METHODS: Costing was performed from the provider's perspective. Unit costs were obtained from the Ivorian Programme national de lutte contre le Sida (USD 2015) and discounted at 3%. Net incremental cost-effectiveness ratios (ICER) per adult HIV infection prevented and per disability-adjusted life-years (DALY) averted were estimated over 2015-2030. RESULTS: The 3 most cost-effective and affordable scenarios were the ones that projected current programmatic trends [ICER = $210; 90% uncertainty interval (90% UI): $150-$300], attaining the 90-90-90 objectives among KP and CFSW (ICER = $220; 90% UI: $80-$510), and among KP only (ICER = $290; 90% UI: $90-$660). The least cost-effective scenario was the one that reached the UNAIDS 90-90-90 target accompanied by a 25% point drop in condom use in KP (ICER = $710; 90% UI: $450-$1270). In comparison, the UNAIDS scenario had a net ICER of $570 (90% UI: $390-$900) per DALY averted. CONCLUSIONS: According to commonly used thresholds, accelerating the HIV response can be considered very cost-effective for all scenarios. However, when balancing epidemiological impact, cost-effectiveness, and affordability, scenarios that sustain both high condom use and rates of viral suppression among KP and CFSW seem most promising in Côte d'Ivoire.
BACKGROUND: Despite Côte d'Ivoire epidemic being labeled as "generalized," key populations (KPs) are important to overall transmission. Using a dynamic model of HIV transmission, we previously estimated the impact of several treatment-as-prevention strategies that reached-or missed-the UNAIDS 90-90-90 targets in different populations groups, including KP and clients of female sex workers (CFSWs). To inform program planning and resources allocation, we assessed the cost-effectiveness of these scenarios. METHODS: Costing was performed from the provider's perspective. Unit costs were obtained from the Ivorian Programme national de lutte contre le Sida (USD 2015) and discounted at 3%. Net incremental cost-effectiveness ratios (ICER) per adult HIV infection prevented and per disability-adjusted life-years (DALY) averted were estimated over 2015-2030. RESULTS: The 3 most cost-effective and affordable scenarios were the ones that projected current programmatic trends [ICER = $210; 90% uncertainty interval (90% UI): $150-$300], attaining the 90-90-90 objectives among KP and CFSW (ICER = $220; 90% UI: $80-$510), and among KP only (ICER = $290; 90% UI: $90-$660). The least cost-effective scenario was the one that reached the UNAIDS 90-90-90 target accompanied by a 25% point drop in condom use in KP (ICER = $710; 90% UI: $450-$1270). In comparison, the UNAIDS scenario had a net ICER of $570 (90% UI: $390-$900) per DALY averted. CONCLUSIONS: According to commonly used thresholds, accelerating the HIV response can be considered very cost-effective for all scenarios. However, when balancing epidemiological impact, cost-effectiveness, and affordability, scenarios that sustain both high condom use and rates of viral suppression among KP and CFSW seem most promising in Côte d'Ivoire.
Authors: Mathieu Maheu-Giroux; Kimberly Marsh; Carla M Doyle; Arnaud Godin; Charlotte Lanièce Delaunay; Leigh F Johnson; Andreas Jahn; Kouamé Abo; Francisco Mbofana; Marie-Claude Boily; David L Buckeridge; Catherine A Hankins; Jeffrey W Eaton Journal: AIDS Date: 2019-12-15 Impact factor: 4.177
Authors: Meghan C DiCarlo; Gina A Dallabetta; Chris Akolo; Sergio Bautista-Arredondo; H Victor Digolo; Virginia A Fonner; Grace Jill Kumwenda; Patrick Mbulaje; Peninah W Mwangi; Navindra E Persuad; Simon Sikwese; Tisha A Wheeler; R Cameron Wolf; Hally R Mahler Journal: J Int AIDS Soc Date: 2022-07 Impact factor: 6.707
Authors: Marc d'Elbée; Métogara Mohamed Traore; Kéba Badiane; Anthony Vautier; Arlette Simo Fotso; Odé Kanku Kabemba; Nicolas Rouveau; Peter Godfrey-Faussett; Mathieu Maheu-Giroux; Marie-Claude Boily; Graham Francis Medley; Joseph Larmarange; Fern Terris-Prestholt Journal: Front Public Health Date: 2021-05-24