Cost-Effectiveness of Accelerated HIV Response Scenarios in Côte d'Ivoire


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Abstract

Background:Despite Côte d'Ivoire epidemic being labeled as “generalized,” key populations (KPs) are important to overall transmission. Using a dynamic model of HIV transmission, we previously estimated the impact of several treatment-as-prevention strategies that reached—or missed—the UNAIDS 90-90-90 targets in different populations groups, including KP and clients of female sex workers (CFSWs). To inform program planning and resources allocation, we assessed the cost-effectiveness of these scenarios.Methods:Costing was performed from the provider's perspective. Unit costs were obtained from the Ivorian Programme national de lutte contre le Sida (USD 2015) and discounted at 3%. Net incremental cost-effectiveness ratios (ICER) per adult HIV infection prevented and per disability-adjusted life-years (DALY) averted were estimated over 2015–2030.Results:The 3 most cost-effective and affordable scenarios were the ones that projected current programmatic trends [ICER = $210; 90% uncertainty interval (90% UI): $150–$300], attaining the 90-90-90 objectives among KP and CFSW (ICER = $220; 90% UI: $80–$510), and among KP only (ICER = $290; 90% UI: $90–$660). The least cost-effective scenario was the one that reached the UNAIDS 90-90-90 target accompanied by a 25% point drop in condom use in KP (ICER = $710; 90% UI: $450–$1270). In comparison, the UNAIDS scenario had a net ICER of $570 (90% UI: $390–$900) per DALY averted.Conclusions:According to commonly used thresholds, accelerating the HIV response can be considered very cost-effective for all scenarios. However, when balancing epidemiological impact, cost-effectiveness, and affordability, scenarios that sustain both high condom use and rates of viral suppression among KP and CFSW seem most promising in Côte d'Ivoire.

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