Universal HIV Testing In India Would Be Cost-Effective, Study

A new study has determined that providing universal HIV testing for India’s one billion-plus population would prove to be a cost-effective approach to managing the epidemic.

AsianScientist (Jun. 19, 2013) – In India most people who are HIV positive don’t know it, yet testing and treatment are relatively cheap and readily available. It would therefore meet international standards of cost-effectiveness — and save millions of lives for decades — to test every person in the one billion-plus population every five years according to a new study published in the PLoS One.

The findings are based on a careful analysis of India’s HIV epidemic using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model, a sophisticated statistical tool that has already been used in HIV policymaking in France, South Africa, and other countries.

An international team of researchers integrated scores of factors specific to the country to find that testing for the whole country would pay off despite India’s huge population. This is true even for scenarios where high-risk groups and areas are tested at higher frequencies.

“The paper explores various strategies and suggests cost-effective options for HIV testing in India,” said Dr Soumya Swaminathan, a co-author of the study, who believes that the projections from the study will help India in its battle with the HIV epidemic, already one of the world’s largest.

“As India moves ahead in its HIV prevention activities and aims for zero new infections, expanding testing will be a key priority and this analysis should help policymakers make the best decisions.”

Definition of cost-effectiveness

The main results from the model are projections of the dollar cost per year of extended lifespan. The World Health Organization’s standard for cost effectiveness is an expenditure that is less than three times the per capita GDP of a country.

In India, per capita GDP was US$1,300 in 2010. A program is therefore defined as cost-effective if calculations show that an expense of less than US$3,900 is required to save a year of someone’s life.

Modern antiretroviral therapies can give HIV-positive individuals a normal lifespan, and in India, which has a thriving generic pharmaceutical sector, first-line HIV therapy costs only US$8.61 a month. HIV tests, meanwhile, cost only US$3.33.

Using these figures, the team ran the models not only for the general population but also for people in high-risk districts and high-risk groups. They first determined the costs and effectiveness of broader and more frequent testing and then compared the results to what would happen under the status quo, in which there is less-than-universal testing.

The findings

Testing the general population just once would be “very cost-effective” because it would cost US$1,100 per year of life saved (YLS) in general and US$800 per YLS among high-risk populations.

Testing the population every five years would be “cost-effective” with a price of US$1,900 per YLS saved in general, and US$1,300 per YLS among high-risk groups.

Testing annually would not be cost-effective for the general population (US$4,000/YLS), but would be for high-risk people (US$1,800/YLS).

The general trends of cost effectiveness remained even after “sensitivity” analyses in which the researchers entered different statistical assumptions in the model in case their assumptions were too optimistic.

Addressing an epidemic

According to the researchers, the main benefit of national testing would simply be getting more people to learn they are positive and therefore to seek effective care before they have full-blown AIDS and a complication.

A secondary benefit would be to curb transmission of the virus, as the behavior of HIV-positive persons may change after a positive test and therapy can reduce transmissibility.

The researchers hope that their study will provide a useful scientific tool for the National AIDS Control Organization of India in planning the HIV testing strategies nationwide.

The article can be found at: Venkatesh et al. (2013) Clinical Impact And Cost-Effectiveness Of Expanded Voluntary HIV Testing In India.

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Source: Brown University; Photo: Karen Philippi/Brown University.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

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