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Article

Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old

1
Department of Industrial & Systems Engineering, University of Washington, Seattle, WA 98185, USA
2
Department of Pediatrics, Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
3
Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55408, USA
4
Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA 98105, USA
5
Seattle Children’s Research Institute, Seattle, WA 98101, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Brooke Nichols
Diagnostics 2021, 11(3), 567; https://doi.org/10.3390/diagnostics11030567
Received: 5 January 2021 / Revised: 15 March 2021 / Accepted: 16 March 2021 / Published: 21 March 2021
(This article belongs to the Special Issue HIV Diagnosis, Treatment, and Care)
Improvement of antiretroviral therapy (ART) regimen switching practices and implementation of pretreatment drug resistance (PDR) testing are two potential approaches to improve health outcomes for children living with HIV. We developed a microsimulation model of disease progression and treatment focused on children with perinatally acquired HIV in sub-Saharan Africa who initiate ART at 3 years of age. We evaluated the cost-effectiveness of diagnostic-based strategies (improved switching and PDR testing), over a 10-year time horizon, in settings without and with pediatric dolutegravir (DTG) availability as first-line ART. The improved switching strategy increases the probability of switching to second-line ART when virologic failure is diagnosed through viral load testing. The PDR testing strategy involves a one-time PDR test prior to ART initiation to guide choice of initial regimen. When DTG is not available, PDR testing is dominated by the improved switching strategy, which has an incremental cost-effectiveness ratio (ICER) of USD 579/life-year gained (LY), relative to the status quo. If DTG is available, improved switching has a similar ICER (USD 591/LY) relative to the DTGstatus quo. Even when substantial financial investment is needed to achieve improved regimen switching practices, the improved switching strategy still has the potential to be cost-effective in a wide range of sub-Saharan African countries. Our analysis highlights the importance of strengthening existing laboratory monitoring systems to improve the health of children living with HIV. View Full-Text
Keywords: HIV; pretreatment drug resistance; regimen switching; drug resistance testing; NNRTI-based ART; dolutegravir-based ART; Africa; virologic failure HIV; pretreatment drug resistance; regimen switching; drug resistance testing; NNRTI-based ART; dolutegravir-based ART; Africa; virologic failure
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MDPI and ACS Style

Siriruchatanon, M.; Liu, S.; Carlucci, J.G.; Enns, E.A.; Duarte, H.A. Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old. Diagnostics 2021, 11, 567. https://doi.org/10.3390/diagnostics11030567

AMA Style

Siriruchatanon M, Liu S, Carlucci JG, Enns EA, Duarte HA. Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old. Diagnostics. 2021; 11(3):567. https://doi.org/10.3390/diagnostics11030567

Chicago/Turabian Style

Siriruchatanon, Mutita, Shan Liu, James G. Carlucci, Eva A. Enns, and Horacio A. Duarte 2021. "Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old" Diagnostics 11, no. 3: 567. https://doi.org/10.3390/diagnostics11030567

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