Modeling the Cost-Effectiveness of Home-Based HIV Testing and Education (HOPE) for Pregnant Women and Their Male Partners in Nyanza Province, Kenya

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 72 Suppl 2; no. 2; pp. S174 - S180
• Main Authors: Sharma, Monisha, Farquhar, Carey, Ying, Roger, Krakowiak, Daisy, Kinuthia, John, Osoti, Alfred, Asila, Victor, Gone, Molly, Mark, Jennifer, Barnabas, Ruanne V
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-08-2016; Lippincott Williams & Wilkins Ovid Technologies; JAIDS Journal of Acquired Immune Deficiency Syndromes
• Subjects: AIDS Serodiagnosis - economics; AIDS Serodiagnosis - statistics & numerical data; AIDS/HIV; Cost analysis; Cost-Benefit Analysis; Couples; Female; HIV; HIV Infections - diagnosis; HIV Infections - prevention & control; HIV Infections - transmission; Home Care Services; Home medical tests; Human immunodeficiency virus; Humans; Kenya; Male; Males; Models, Economic; Patient Education as Topic; Pregnancy; Sexual Partners; Supplement; Women; Sub-Saharan Africa; Kenya, Nyanza; Kenya, Nyanza, Kisumu; Kenya; Africa
• ISSN: 1525-4135; 1944-7884
• 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 Kenyaʼs per capita gross domestic product ($1358) and are therefore considered cost-effective. Task-shifting to community health workers can increase intervention affordability and feasibility.