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5th International AIDS Society Conference on HIV Pathogenesis and TreatmentCape Town - July 19 - 22, 2009 |
COST EFFECTIVE MODEL FOR REDUCED SAMPLING OF VIRAL LOADS FOR MONITORING ANTI-RETROVIRAL THERAPY IN RESOURCE LIMITED SETTINGS
IAS Conf HIV Pathog Treat 2009 Jul 19-22;5th: Abstract No. MOPDD106
P. Keiser
1,2, S. Ojoo2, I. Mwangi2, N. Smith2
1University of Texas Medical Branch, Infectous Diseases, Galveston, United States, 2University of Maryland Institute for Human Virology-Kenya, Nairobi, Kenya
BACKGROUND: Viral load monitoring (VLM) of anti-retroviral therapy (ART) in developing countries is rarely used because of high costs. Studies showing CD4 monitoring to be cost effective typically perform VLM every six months. Reducing the frequency of VLM and new technologies may reduce the cost to where it is financially feasible. We developed a model to compare the effectiveness of 3 different schemes of VLM.
METHODS: Three schemes for VLM were tested: Reduced VLM (RVLM) (CD4 count at and VLM at 6, 18 and 60 months); US DHHS Treatment Guidelines (DHHS) (CD4 counts and VLM at baseline and every 6 months); Kenyan National Guidelines (NASCOP) CD4 counts at baseline and every six months without VLM). Time to failure was modeled from a cohort of 313 HIV infected patients treated with zidovudine, lamivudine and efavirenz using Kaplan-Meier analysis Time to detection thymidine analogue mutations (TAMs) were calculated from published sources The cost were calculated from the prices of tests available for monitoring in resource limited settings.
RESULTS: Time to detection of failure for RVLM was 147 days (95% CI=136-156); for DHHS, it was 115 days (95% CI=100-129), for NASCOP, it was 1110 days (95% CI=987-1263 days). Minimum time to the development of 1st TAM was 120 days and the median time was 594 days. Cost of each sampling scheme was as follows: RVLT =$21/pt/yr, DHHS =$57/pt/yr, NASCOP =$10/pt/yr.
CONCLUSIONS: RVLM detected failure later than DHHS testing but significantly sooner than CD4 count monitoring alone, Risk of development of multiple TAMs was low in both VLM schemes but high in CD4 monitoring. Cost of RVLM was higher than CD4 count monitoring alone but less than DHHS monitoring. We conclude that RVLM is a potentially effective method of monitoring ART in resource limited settings.
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2009-07-22
MOPDD106
Operations Research to Improve Laboratory Diagnosis and Monitoring
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