Cost-effectiveness analysis of home-based HIV testing and education for pregnant women and their male partners in Kenya

Modeling the cost-effectiveness of home-based HIV testing and education (HOPE) for pregnant women and their male partners in Nyanza Province, Kenya.

Sharma M, Farquhar C, Ying R, Krakowiak D, Kinuthia J, Osoti A, Asila V, Gone M, Mark J, Barnabas RV. J Acquir Immune Defic Syndr. 2016 Aug 1;72 Suppl 2:S174-80. doi: 10.1097/QAI.0000000000001057.

Introduction: Women in sub-Saharan Africa face a 2-fold higher risk of HIV acquisition during pregnancy and postpartum and the majority do not know the HIV status of their male partner. Home-based couple HIV testing for pregnant women can reduce HIV transmission to women and infants while increasing antiretroviral therapy (ART) coverage in men. However, the cost-effectiveness of this program has not been evaluated.

Methods: We modeled the health and economic impact of implementing a home-based partner education and HIV testing (HOPE) intervention for pregnant women and their male partners in a region of Western Kenya (formally Nyanza Province). We used data from the HOPE randomized clinical trial conducted in Kisumu, Kenya, to parameterize a mathematical model of HIV transmission. We conducted an in-country microcosting of the HOPE intervention (payer perspective) to estimate program costs as well as a lower cost scenario of task-shifting to community health workers.

Results: The incremental cost of adding the HOPE intervention to standard antenatal care was $31-37 and $14-16 USD per couple tested with program and task-shifting costs, respectively. At 60% coverage of male partners, HOPE was projected to avert 6987 HIV infections and 2603 deaths in Nyanza province over 10 years with an incremental cost-effectiveness ratio (ICER) of $886 and $615 per disability-adjusted life year averted for the program and task-shifting scenario, respectively. ICERs were robust to changes in intervention coverage, effectiveness, and ART initiation and dropout rates.

Conclusions: The HOPE intervention can moderately decrease HIV-associated morbidity and mortality by increasing ART coverage in male partners of pregnant women. ICERs fall below Kenya's per capita gross domestic product ($1358) and are therefore considered cost-effective. Task-shifting to community health workers can increase intervention affordability and feasibility.

Abstract access [1]

Editor’s notes: HIV remains one of the most serious public health and economic challenges in sub-Saharan Africa. In this study, a deterministic mathematical model was used to assess the cost-effectiveness of providing home-based partner education and HIV testing to couples as a part of routine antenatal care in western Kenya. Detailed cost and effectiveness data were obtained from home-based partner education and an HIV testing programme in Kisumu, Kenya. The model was parameterised using data from that region. The model was analysed for two scenarios; the status quo (with no activity) and the activity scenario in which home-based partner education and HIV testing was added to the status quo with 60% coverage of male partners of pregnant women. Sensitivity analysis was conducted to ascertain the robustness of key model assumption on the study findings.  The authors found home-based partner education and HIV testing activities to be a cost-effective method to reduce HIV disease prevalence in Kenya as it increases ART coverage in male partners of pregnant women. This is a very interesting study which confirms previous findings that community-based HIV counselling and testing is cost-effective. 

HIV testing and treatment [3]
Africa [4]
Kenya [5]
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