Projecting the Epidemiological Effect, Cost-Effectiveness and Transmission of HIV Drug Resistance in Vietnam Associated With Viral Load Monitoring Strategies

J Antimicrob Chemother. 2016 May;71(5):1367-79. doi: 10.1093/jac/dkv473. Epub 2016 Feb 10.

Abstract

Objectives: The objective of this study was to investigate the potential epidemiological impact of viral load (VL) monitoring and its cost-effectiveness in Vietnam, where transmitted HIV drug resistance (TDR) prevalence has increased from <5% to 5%-15% in the past decade.

Methods: Using a population-based mathematical model driven by data from Vietnam, we simulated scenarios of various combinations of VL testing coverage, VL thresholds for second-line ART initiation and availability of HIV drug-resistance tests. We assessed the cost per disability-adjusted life year (DALY) averted for each scenario.

Results: Projecting expected ART scale-up levels, to approximately double the number of people on ART by 2030, will lead to an estimated 18 510 cases (95% CI: 9120-34 600 cases) of TDR and 55 180 cases (95% CI: 40 540-65 900 cases) of acquired drug resistance (ADR) in the absence of VL monitoring. This projection corresponds to a TDR prevalence of 16% (95% CI: 11%-24%) and ADR of 18% (95% CI: 15%-20%). Annual or biennial VL monitoring with 30% coverage is expected to relieve 12%-31% of TDR (2260-5860 cases), 25%-59% of ADR (9620-22 650 cases), 2%-6% of HIV-related deaths (360-880 cases) and 19 270-51 400 DALYs during 2015-30. The 30% coverage of VL monitoring is estimated to cost US$4848-5154 per DALY averted. The projected additional cost for implementing this strategy is US$105-268 million over 2015-30.

Conclusions: Our study suggests that a programmatically achievable 30% coverage of VL monitoring can have considerable benefits for individuals and leads to population health benefits by reducing the overall national burden of HIV drug resistance. It is marginally cost-effective according to common willingness-to-pay thresholds.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Drug Monitoring / economics*
  • Drug Monitoring / methods
  • Drug Resistance, Viral*
  • Female
  • HIV / isolation & purification*
  • HIV Infections / epidemiology*
  • HIV Infections / virology*
  • Humans
  • Male
  • Models, Theoretical
  • Prospective Studies
  • Vietnam / epidemiology
  • Viral Load / economics*
  • Viral Load / methods

Substances

  • Antiviral Agents