Ying, R., Sharma, M., Celum, C., et al. The Lancet HIV (May 2016), doi: http://dx.doi.org/10.1016/S2352-3018(16)30009-1.
This study used a mathematical model of HIV transmission in KwaZulu-Natal to estimate the effectiveness and cost-effectiveness of expanding antiretroviral therapy (ART) through home HIV testing and counseling (HTC), with linkage to care and ART initiation based on either CD4 count alone, or CD4 combined with viral load data. For a scenario of home HTC every five years, the authors calculated the incremental cost-effectiveness ratio per HIV infection, HIV-associated death averted, and quality-adjusted life-years gained. The model showed that home HTC every five years, with linkage to care and ART initiation at CD4 counts of 350 cells/μL or less, reduced HIV incidence by 40.6 percent over ten years. Expanding ART to people with CD4 counts above 350 cells/μL who also have a viral load of 10,000 copies/mL or more showed an additional decrease in HIV incidence by 51.6 percent. Thus, combining CD4 and viral load counts was the most cost-effective strategy for preventing HIV infections, at USD$2,960 per infection averted. The authors concluded that providing province-wide home HTC every five years was a cost-effective strategy for increasing ART coverage and reducing HIV burden. They recommended expanding home HTC and integrating these strategies into existing HIV programs.