Cryptococcal Meningitis Screening and Community-based Early Adherence Support, in sub-Sahara Africa

Godfather Dickson Kimaro, Lorna Guinness, Tinevimbo Shiri, Sokoine Kivuyo, Duncan Chanda, Christian Bottomley, Tao Chen, Amos Kahwa, Neil Hawkins, Peter Mwaba, Sayoki Godfrey Mfinanga, Thomas S Harrison, Shabbar Jaffar, Louis W Niessen

Overview

Screening and home visits improve survival.

Summary

Cryptococcal meningitis is a leading killer in HIV.

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Author Comments

Prof Louis W Niessen, MD, PhD
Prof Louis W Niessen, MD, PhD
Liverpool School of Tropical Medicine / University of Warwick
Professor
Public health; health economics
Liverpool, MERSEYSIDE | United Kingdom
Relevant work with a great team, addressing a major remaining HIV-related problem within the African context. Prof Louis W Niessen, MD, PhD

Resources

ResearchGate
https://www.researchgate.net/profile/Louis_Niessen

Cryptococcal Meningitis Screening and Community-based Early Adherence Support in People With Advanced Human Immunodeficiency Virus Infection Starting Antiretroviral Therapy in Tanzania and Zambia: A Cost-effectiveness Analysis.

Authors:
Prof Louis W Niessen, MD, PhD
Prof Louis W Niessen, MD, PhD
Liverpool School of Tropical Medicine / University of Warwick
Professor
Public health; health economics
Liverpool, MERSEYSIDE | United Kingdom

Clin Infect Dis 2020 Apr;70(8):1652-1657

Department of International Public Health, Liverpool School of Tropical Medicine, United Kingdom.

Background: A randomized trial demonstrated that among people living with late-stage human immunodeficiency virus (HIV) infection initiating antiretroviral therapy, screening serum for cryptococcal antigen (CrAg) combined with adherence support reduced all-cause mortality by 28%, compared with standard clinic-based care. Here, we present the cost-effectiveness.

Methods: HIV-infected adults with CD4 count <200 cells/μL were randomized to either CrAg screening plus 4 weekly home visits to provide adherence support or to standard clinic-based care in Dar es Salaam and Lusaka. The primary economic outcome was health service care cost per life-year saved as the incremental cost-effectiveness ratio (ICER), based on 2017 US dollars. We used nonparametric bootstrapping to assess uncertainties and univariate deterministic sensitivity analysis to examine the impact of individual parameters on the ICER.

Results: Among the intervention and standard arms, 1001 and 998 participants, respectively, were enrolled. The annual mean cost per participant in the intervention arm was US$339 (95% confidence interval [CI], $331-$347), resulting in an incremental cost of the intervention of US$77 (95% CI, $66-$88). The incremental cost was similar when analysis was restricted to persons with CD4 count <100 cells/μL. The ICER for the intervention vs standard care, per life-year saved, was US$70 (95% CI, $43-$211) for all participants with CD4 count up to 200 cells/μL and US$91 (95% CI, $49-$443) among those with CD4 counts <100 cells /μL. Cost-effectveness was most sensitive to mortality estimates.

Conclusions: Screening for cryptococcal antigen combined with a short period of adherence support, is cost-effective in resource-limited settings.

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Source
http://dx.doi.org/10.1093/cid/ciz453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146002PMC
April 2020
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8.886 Impact Factor

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