The cost-effectiveness of prophylaxis strategies for individuals with advanced HIV starting treatment in Africa
- Walker, Simon M.
- Cox, Edward
- Revill, Paul
- Musiime, Victor
- Bwakura-Dangarembizi, Mutsa
- Mallewa, Jane
- Cheruiyot, Priscilla
- Maitland, Kathryn
- Ford, Nathan
- Gibb, Diana M.
- Walker, A. Sarah
- Soares, Marta
- Mugyenyi, P.
- Kityo, C.
- Musiime, V.
- Wavamunno, P.
- Nambi, E.
- Ocitti, P.
- Ndigendawani, M.
- Kabahenda, S.
- Kemigisa, M.
- Acen, J.
- Olebo, D.
- Mpamize, G.
- Amone, A.
- Okweny, D.
- Mbonye, A.
- Nambaziira, F.
- Rweyora, A.
- Kangah, M.
- Kabaswahili, V.
- Abach, J.
- Abongomera, G.
- Omongin, J.
- Aciro, I.
- Philliam, A.
- Arach, B.
- Ocung, E.
- Amone, G.
- Miles, P.
- Adong, C.
- Tumsuiime, C.
- Kidega, P.
- Otto, B.
- Apio, F.
- Baleeta, K.
- Mukuye, A.
- Abwola, M.
- Ssennono, F.
- Baliruno, D.
DOIAbstract
Introduction: Many HIV-positive individuals in Africa have advanced disease when initiating antiretroviral therapy (ART) so have high risks of opportunistic infections and death. The REALITY trial found that an enhanced-prophylaxis package including fluconazole reduced mortality by 27% in individuals starting ART with CD4 <100 cells/mm 3. We investigated the cost-effectiveness of this enhanced-prophylaxis package versus other strategies, including using cryptococcal antigen (CrAg) testing, in individuals with CD4 <200 cells/mm 3 or <100 cells/mm 3 at ART initiation and all individuals regardless of CD4 count. Methods: The REALITY trial enrolled from June 2013 to April 2015. A decision-analytic model was developed to estimate the cost-effect...
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