Brooke E Nichols1,2, Sarah J Girdwood2, Aaron Shibemba3, Sharper Sikota4,5, Christopher J Gill1, Lawrence Mwananyanda1,4, Lara Noble6, Lynsey Stewart-Isherwood6,7, Lesley Scott6, Sergio Carmona6,7, Sydney Rosen1,2, Wendy Stevens6,7. 1. Department of Global Health, School of Public Health, Boston University, Massachusetts. 2. Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 3. Ministry of Health, Lusaka. 4. Right to Care Zambia, Lusaka. 5. Liverpool John Moores University, United Kingdom. 6. Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand. 7. National Health Laboratory Service, Johannesburg, South Africa.
Abstract
BACKGROUND: Routine plasma viral load (VL) testing is recommended for monitoring human immunodeficiency virus-infected patients on antiretroviral therapy. In Zambia, VL scale-up is limited due to logistical obstacles around plasma specimen collection, storage, and transport to centralized laboratories. Dried blood spots (DBSs) could circumvent many logistical challenges at the cost of increased misclassification. Recently, plasma separation cards (PSCs) have become available and, though more expensive, have lower total misclassification than DBSs. METHODS: Using a geospatial model created for optimizing VL utilization in Zambia, we estimated the short-term cost of uptake/correct VL result using either DBSs or PSCs to increase VL access on equipment available in-country. Five scenarios were modeled: (1) plasma only (status quo); (2) plasma at high-volume sites, DBS at low-volume sites; (3) plasma at high-volume sites, PSC at low-volume sites; (4) PSC only; (5) DBS only. RESULTS: Scenario 1 resulted in 795 342 correct results due to limited patient access. When allowing for full and partial adoption of dried specimens, access increases by 19%, with scenario 3 producing the greatest number of correct results expected (929 857). The average cost per correct VL result was lowest in the plasma + DBS scenario at $30.90 compared to $31.62 in our plasma + PSC scenario. The cost per correct result of using dried specimens only was dominated in the incremental analysis, due primarily to fewer correct results. CONCLUSIONS: Adopting the partial use of dried specimens will help achieve improved VL access for patients at the lowest cost per correct result.
BACKGROUND: Routine plasma viral load (VL) testing is recommended for monitoring humanimmunodeficiency virus-infectedpatients on antiretroviral therapy. In Zambia, VL scale-up is limited due to logistical obstacles around plasma specimen collection, storage, and transport to centralized laboratories. Dried blood spots (DBSs) could circumvent many logistical challenges at the cost of increased misclassification. Recently, plasma separation cards (PSCs) have become available and, though more expensive, have lower total misclassification than DBSs. METHODS: Using a geospatial model created for optimizing VL utilization in Zambia, we estimated the short-term cost of uptake/correct VL result using either DBSs or PSCs to increase VL access on equipment available in-country. Five scenarios were modeled: (1) plasma only (status quo); (2) plasma at high-volume sites, DBS at low-volume sites; (3) plasma at high-volume sites, PSC at low-volume sites; (4) PSC only; (5) DBS only. RESULTS: Scenario 1 resulted in 795 342 correct results due to limited patient access. When allowing for full and partial adoption of dried specimens, access increases by 19%, with scenario 3 producing the greatest number of correct results expected (929 857). The average cost per correct VL result was lowest in the plasma + DBS scenario at $30.90 compared to $31.62 in our plasma + PSC scenario. The cost per correct result of using dried specimens only was dominated in the incremental analysis, due primarily to fewer correct results. CONCLUSIONS: Adopting the partial use of dried specimens will help achieve improved VL access for patients at the lowest cost per correct result.
Authors: Brooke E Nichols; Sarah J Girdwood; Thomas Crompton; Lynsey Stewart-Isherwood; Leigh Berrie; Dorman Chimhamhiwa; Crispin Moyo; John Kuehnle; Wendy Stevens; Sydney Rosen Journal: J Int AIDS Soc Date: 2019-09 Impact factor: 5.396
Authors: Sarah J Girdwood; Brooke E Nichols; Crispin Moyo; Thomas Crompton; Dorman Chimhamhiwa; Sydney Rosen Journal: PLoS One Date: 2019-08-26 Impact factor: 3.240
Authors: Laura Doornekamp; Carmen W E Embregts; Georgina I Aron; Simone Goeijenbier; David A M C van de Vijver; Eric C M van Gorp; Corine H GeurtsvanKessel Journal: PLoS Negl Trop Dis Date: 2020-10-13
Authors: Brooke E Nichols; Refiloe Cele; Lise Jamieson; Lawrence C Long; Zumbe Siwale; Patrick Banda; Crispin Moyo; Sydney Rosen Journal: AIDS Date: 2021-02-02 Impact factor: 4.632