The Clinical and Economic Impact of Point-of-Care CD4 Testing in Mozambique and Other Resource-Limited Settings: A Cost-Effectiveness Analysis
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{"title"=>"The Clinical and Economic Impact of Point-of-Care CD4 Testing in Mozambique and Other Resource-Limited Settings: A Cost-Effectiveness Analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Emily P.", "last_name"=>"Hyle", "scopus_author_id"=>"8634799500"}, {"first_name"=>"Ilesh V.", "last_name"=>"Jani", "scopus_author_id"=>"6507260861"}, {"first_name"=>"Jonathan", "last_name"=>"Lehe", "scopus_author_id"=>"36158454800"}, {"first_name"=>"Amanda E.", "last_name"=>"Su", "scopus_author_id"=>"56326204600"}, {"first_name"=>"Robin", "last_name"=>"Wood", "scopus_author_id"=>"7404053384"}, {"first_name"=>"Jorge", "last_name"=>"Quevedo", "scopus_author_id"=>"42662079000"}, {"first_name"=>"Elena", "last_name"=>"Losina", "scopus_author_id"=>"7003799126"}, {"first_name"=>"Ingrid V.", "last_name"=>"Bassett", "scopus_author_id"=>"7003499474"}, {"first_name"=>"Pamela P.", "last_name"=>"Pei", "scopus_author_id"=>"55560485000"}, {"first_name"=>"A. David", "last_name"=>"Paltiel", "scopus_author_id"=>"7004306826"}, {"first_name"=>"Stephen", "last_name"=>"Resch", "scopus_author_id"=>"35874179600"}, {"first_name"=>"Kenneth A.", "last_name"=>"Freedberg", "scopus_author_id"=>"7004947755"}, {"first_name"=>"Trevor", "last_name"=>"Peter", "scopus_author_id"=>"7102011028"}, {"first_name"=>"Rochelle P.", "last_name"=>"Walensky", "scopus_author_id"=>"6602540593"}], "year"=>2014, "source"=>"PLoS Medicine", "identifiers"=>{"pui"=>"600193985", "sgr"=>"84907959202", "pmid"=>"25225800", "scopus"=>"2-s2.0-84907959202", "isbn"=>"1549-1676 (Electronic)\\r1549-1277 (Linking)", "doi"=>"10.1371/journal.pmed.1001725", "issn"=>"15491676"}, "id"=>"77d73556-7bf1-3ee6-a7bf-83bc7cc608ee", "abstract"=>"BACKGROUND: Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique.\\n\\nMETHODS AND FINDINGS: We use a validated model of HIV testing, linkage, and treatment (CEPAC-International) to examine two strategies of immunological staging in Mozambique: (1) laboratory-based CD4 testing (LAB-CD4) and (2) point-of-care CD4 testing (POC-CD4). Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs). Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%), probability of correctly detecting antiretroviral therapy (ART) eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90%) or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%), and test cost (LAB-CD4, US$10; POC-CD4, US$24). In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570) to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%-61.0%), increasing to 65.0% (95% CI, 64.9%-65.1%) with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6-9.6 y) and US$2,440 (95% CI, US$2,440-US$2,450) and increase with POC-CD4 to 10.3 y (95% CI, 10.3-10.3 y) and US$2,800 (95% CI, US$2,790-US$2,800); the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS) (95% CI, US$480-US$520/YLS). POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity/specificity and higher cost than published values. In other resource-limited settings with fewer opportunities to access care, POC-CD4 has a greater impact on clinical outcomes and remains cost-effective compared to LAB-CD4. Limitations of the analysis include the uncertainty around input parameters, which is examined in sensitivity analyses. The potential added benefits due to decreased transmission are excluded; their inclusion would likely further increase the value of POC-CD4 compared to LAB-CD4.\\n\\nCONCLUSIONS: POC-CD4 at the time of HIV diagnosis could improve survival and be cost-effective compared to LAB-CD4 in Mozambique, if it improves linkage to care. POC-CD4 could have the greatest impact on mortality in settings where resources for HIV testing and linkage are most limited. Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/clinical-economic-impact-pointofcare-cd4-testing-mozambique-other-resourcelimited-settings-costeffec", "reader_count"=>80, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Professor > Associate Professor"=>2, "Researcher"=>20, "Student > Doctoral Student"=>6, "Student > Ph. D. Student"=>14, "Student > Postgraduate"=>5, "Other"=>9, "Student > Master"=>12, "Student > Bachelor"=>4, "Lecturer"=>4, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Professor > Associate Professor"=>2, "Researcher"=>20, "Student > Doctoral Student"=>6, "Student > Ph. D. 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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1677838", "https://ndownloader.figshare.com/files/1677839", "https://ndownloader.figshare.com/files/1677840"], "description"=>"<div><p>Background</p><p>Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique.</p><p>Methods and Findings</p><p>We use a validated model of HIV testing, linkage, and treatment (CEPAC-International) to examine two strategies of immunological staging in Mozambique: (1) laboratory-based CD4 testing (LAB-CD4) and (2) point-of-care CD4 testing (POC-CD4). Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs). Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%), probability of correctly detecting antiretroviral therapy (ART) eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90%) or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%), and test cost (LAB-CD4, US$10; POC-CD4, US$24). In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570) to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%–61.0%), increasing to 65.0% (95% CI, 64.9%–65.1%) with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6–9.6 y) and US$2,440 (95% CI, US$2,440–US$2,450) and increase with POC-CD4 to 10.3 y (95% CI, 10.3–10.3 y) and US$2,800 (95% CI, US$2,790–US$2,800); the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS) (95% CI, US$480–US$520/YLS). POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity/specificity and higher cost than published values. In other resource-limited settings with fewer opportunities to access care, POC-CD4 has a greater impact on clinical outcomes and remains cost-effective compared to LAB-CD4. Limitations of the analysis include the uncertainty around input parameters, which is examined in sensitivity analyses. The potential added benefits due to decreased transmission are excluded; their inclusion would likely further increase the value of POC-CD4 compared to LAB-CD4.</p><p>Conclusions</p><p>POC-CD4 at the time of HIV diagnosis could improve survival and be cost-effective compared to LAB-CD4 in Mozambique, if it improves linkage to care. POC-CD4 could have the greatest impact on mortality in settings where resources for HIV testing and linkage are most limited.</p><p><i>Please see later in the article for the Editors' Summary</i></p></div>", "links"=>[], "tags"=>["sensitivity analyses", "impact", "survival", "HIV testing", "HIV diagnosis", "linkage", "icer", "mozambique", "YLS", "person lifetime costs", "outcome", "ci", "setting", "parameter"], "article_id"=>1171358, "categories"=>["Uncategorised"], "users"=>["Emily P. Hyle", "Ilesh V. Jani", "Jonathan Lehe", "Amanda E. Su", "Robin Wood", "Jorge Quevedo", "Elena Losina", "Ingrid V. Bassett", "Pamela P. Pei", "A. David Paltiel", "Stephen Resch", "Kenneth A. Freedberg", "Trevor Peter", "Rochelle P. Walensky"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001725.s001", "https://dx.doi.org/10.1371/journal.pmed.1001725.s002", "https://dx.doi.org/10.1371/journal.pmed.1001725.s003"], "stats"=>{"downloads"=>9, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_Clinical_and_Economic_Impact_of_Point_of_Care_CD4_Testing_in_Mozambique_and_Other_Resource_Limited_Settings_A_Cost_Effectiveness_Analysis_/1171358", "title"=>"The Clinical and Economic Impact of Point-of-Care CD4 Testing in Mozambique and Other Resource-Limited Settings: A Cost-Effectiveness Analysis", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-09-16 02:51:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/1677835"], "description"=>"<p>Base case results of POC-CD4 versus LAB-CD4 for immunologic staging for HIV-infected persons in Mozambique.</p>", "links"=>[], "tags"=>["sensitivity analyses", "impact", "survival", "HIV testing", "HIV diagnosis", "linkage", "icer", "mozambique", "YLS", "person lifetime costs", "outcome", "ci", "setting", "parameter"], "article_id"=>1171355, "categories"=>["Uncategorised"], "users"=>["Emily P. Hyle", "Ilesh V. Jani", "Jonathan Lehe", "Amanda E. Su", "Robin Wood", "Jorge Quevedo", "Elena Losina", "Ingrid V. Bassett", "Pamela P. Pei", "A. David Paltiel", "Stephen Resch", "Kenneth A. Freedberg", "Trevor Peter", "Rochelle P. Walensky"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001725.t003", "stats"=>{"downloads"=>0, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Base_case_results_of_POC_CD4_versus_LAB_CD4_for_immunologic_staging_for_HIV_infected_persons_in_Mozambique_/1171355", "title"=>"Base case results of POC-CD4 versus LAB-CD4 for immunologic staging for HIV-infected persons in Mozambique.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-09-16 02:51:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/1677829"], "description"=>"<p>A range of parameters varied in one-way sensitivity analyses are displayed on the vertical axis. The ICER (US dollars/YLS) of POC-CD4 compared to LAB-CD4 is represented on the <i>x</i>-axis. The solid vertical line indicates the ICER of the base case (US$500/YLS). The dashed vertical line represents the per capita GDP of Mozambique (MOZ GDP), i.e., the “very cost-effective” threshold; the dotted vertical line represents three times GDP, i.e., the “cost-effective” threshold. For each parameter, the horizontal bar represents the range of ICERs that result from varying that parameter along the range of values indicated in the parentheses; the first value listed in the parentheses is the one that results in the lowest ICER. Of all one-way sensitivity analyses, the ICER of POC-CD4 compared to LAB-CD4 crosses the cost-effectiveness threshold (into the area of not being cost-effective) (US$1,710/YLS) only when point-of-care CD4 test cost is>US$1,100/test or when repeat HIV testing or immunologic staging are completed every 9 mo or more frequently.</p>", "links"=>[], "tags"=>["sensitivity analyses", "impact", "survival", "HIV testing", "HIV diagnosis", "linkage", "icer", "mozambique", "YLS", "person lifetime costs", "outcome", "ci", "setting", "parameter"], "article_id"=>1171349, "categories"=>["Uncategorised"], "users"=>["Emily P. Hyle", "Ilesh V. Jani", "Jonathan Lehe", "Amanda E. Su", "Robin Wood", "Jorge Quevedo", "Elena Losina", "Ingrid V. Bassett", "Pamela P. Pei", "A. David Paltiel", "Stephen Resch", "Kenneth A. Freedberg", "Trevor Peter", "Rochelle P. Walensky"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001725.g003", "stats"=>{"downloads"=>1, "page_views"=>43, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Tornado_diagram_of_one_way_sensitivity_analyses_when_ART_eligibility_threshold_is_at_CD4_count_8804_250_181_l_/1171349", "title"=>"Tornado diagram of one-way sensitivity analyses when ART-eligibility threshold is at CD4 count ≤250/µl.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-09-16 02:51:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/1677828"], "description"=>"<p>At the time of HIV diagnosis and immunologic staging, the model captures both the “true CD4 count” of the patient and the “observed CD4 count,” or CD4 test result. The observed CD4 test result has variability around the true CD4 count, depending on the test itself (e.g., point-of-care CD4 test with precision of 32.6% CV). (A) Using model output, we calculate the sensitivity (i.e., observed CD4 count ≤250/µl, true CD4 count ≤250/µl) and specificity (i.e., observed CD4 count >250/µl, true CD4 count >250/µl) for point-of-care CD4 tests when policy sets ART eligibility at CD4 count ≤250/µl. (B) In a scenario in which ART eligibility is at CD4 count ≤350/µl, we use model output to calculate the sensitivity (i.e., observed CD4 count ≤350/µl, true CD4 count ≤350/µl) and specificity (i.e., observed CD4 count >350/µl, true CD4 count>350/µl) for point-of-care CD4 tests.</p>", "links"=>[], "tags"=>["sensitivity analyses", "impact", "survival", "HIV testing", "HIV diagnosis", "linkage", "icer", "mozambique", "YLS", "person lifetime costs", "outcome", "ci", "setting", "parameter"], "article_id"=>1171348, "categories"=>["Uncategorised"], "users"=>["Emily P. Hyle", "Ilesh V. Jani", "Jonathan Lehe", "Amanda E. Su", "Robin Wood", "Jorge Quevedo", "Elena Losina", "Ingrid V. Bassett", "Pamela P. Pei", "A. David Paltiel", "Stephen Resch", "Kenneth A. Freedberg", "Trevor Peter", "Rochelle P. Walensky"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001725.g002", "stats"=>{"downloads"=>0, "page_views"=>20, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Test_characteristics_of_the_point_of_care_CD4_test_as_determined_by_model_output_/1171348", "title"=>"Test characteristics of the point-of-care CD4 test as determined by model output.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-09-16 02:51:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/1677836"], "description"=>"<p>Base case in bold.</p>a<p>Derived using test performance of percent SD  = 32.6% <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001725#pmed.1001725-Glencross1\" target=\"_blank\">[36]</a>, mean CD4 count (SD) of cohort  = 300/µl (230/µl), and ART-eligibility threshold at CD4 count ≤250/µl,</p>b<p>False positives: patients who are ART ineligible (true CD4 count>250/µl) but are misclassified as ART eligible.</p>c<p>False negatives: patients who are ART eligible (true CD4 count ≤250/µl) but are misclassified as ART ineligible.</p>d<p>Discounted at 3%/y.</p><p>One-way and two-way sensitivity analyses of point-of-care CD4 test characteristics on misclassification of patients, clinical outcomes, costs, and cost-effectiveness compared to laboratory-based CD4 tests.</p>", "links"=>[], "tags"=>["sensitivity analyses", "impact", "survival", "HIV testing", "HIV diagnosis", "linkage", "icer", "mozambique", "YLS", "person lifetime costs", "outcome", "ci", "setting", "parameter"], "article_id"=>1171356, "categories"=>["Uncategorised"], "users"=>["Emily P. Hyle", "Ilesh V. Jani", "Jonathan Lehe", "Amanda E. Su", "Robin Wood", "Jorge Quevedo", "Elena Losina", "Ingrid V. Bassett", "Pamela P. Pei", "A. David Paltiel", "Stephen Resch", "Kenneth A. Freedberg", "Trevor Peter", "Rochelle P. Walensky"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001725.t004", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_One_way_and_two_way_sensitivity_analyses_of_point_of_care_CD4_test_characteristics_on_misclassification_of_patients_clinical_outcomes_costs_and_cost_effectiveness_compared_to_laboratory_based_CD4_tests_/1171356", "title"=>"One-way and two-way sensitivity analyses of point-of-care CD4 test characteristics on misclassification of patients, clinical outcomes, costs, and cost-effectiveness compared to laboratory-based CD4 tests.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-09-16 02:51:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/1677833"], "description"=>"a<p>Overall linkage is varied using point-of-care test completion (83%, SD 13.5%).</p>b<p>Annual routine care costs for patients with CD4 count ≤250/µl are US$250 (SD US$62.5), and for patients with CD4 count>250/µl are US$160 (SD US$40).</p>c<p>Point-of-care test sensitivity (87%–95%) and specificity (76%–96%).</p><p>Input parameters for probabilistic sensitivity analysis of immunological staging by POC-CD4 versus LAB-CD4 in Mozambique.</p>", "links"=>[], "tags"=>["sensitivity analyses", "impact", "survival", "HIV testing", "HIV diagnosis", "linkage", "icer", "mozambique", "YLS", "person lifetime costs", "outcome", "ci", "setting", "parameter"], "article_id"=>1171353, "categories"=>["Uncategorised"], "users"=>["Emily P. Hyle", "Ilesh V. Jani", "Jonathan Lehe", "Amanda E. Su", "Robin Wood", "Jorge Quevedo", "Elena Losina", "Ingrid V. Bassett", "Pamela P. Pei", "A. David Paltiel", "Stephen Resch", "Kenneth A. Freedberg", "Trevor Peter", "Rochelle P. Walensky"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001725.t002", "stats"=>{"downloads"=>1, "page_views"=>21, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Input_parameters_for_probabilistic_sensitivity_analysis_of_immunological_staging_by_POC_CD4_versus_LAB_CD4_in_Mozambique_/1171353", "title"=>"Input parameters for probabilistic sensitivity analysis of immunological staging by POC-CD4 versus LAB-CD4 in Mozambique.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-09-16 02:51:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/1677831"], "description"=>"<p>Projected decrease in 5-y mortality and ICERs with use of POC-CD4 compared to LAB-CD4 in four settings that represent a range of access to care (decreasing access to care from left to right) and with different probabilities of linkage with POC-CD4 (increasing up the vertical axis). The base case is indicated by the X in each figure; the horizontal lines represent the base case overall linkage rates (POC-CD4, solid black; LAB-CD4, dashed white). Decreased mortality at 5 y with POC-CD4 is projected in settings that use current Mozambique guidelines for ART eligibility (CD4 count ≤250/µl) (A) or earlier ART eligibility (CD4 count ≤350/µl) (B). More deaths could be averted (noted by changes in color towards green) in settings with fewer opportunities to access care or by improving POC-CD4 linkage rates compared to LAB-CD4. Blue denotes the few situations in which LAB-CD4 results in better clinical outcomes than POC-CD4 at 5 y. (C) displays the ICERs of POC-CD4 compared with LAB-CD4 given current Mozambique guidelines (ART eligibility at CD4 count ≤250/µl); (D) displays ICERs in settings with earlier ART eligibility (CD4 count ≤350/µl). POC-CD4 is at the very cost-effective threshold (i.e., US$450–US$860/YLS in [C] and US$460–US$1,030/YLS in [D]) compared to LAB-CD4 except when linkage with POC-CD4 is <5% better than LAB-CD4 in settings with repeat HIV testing every 5 y.</p>", "links"=>[], "tags"=>["sensitivity analyses", "impact", "survival", "HIV testing", "HIV diagnosis", "linkage", "icer", "mozambique", "YLS", "person lifetime costs", "outcome", "ci", "setting", "parameter"], "article_id"=>1171351, "categories"=>["Uncategorised"], "users"=>["Emily P. Hyle", "Ilesh V. Jani", "Jonathan Lehe", "Amanda E. Su", "Robin Wood", "Jorge Quevedo", "Elena Losina", "Ingrid V. Bassett", "Pamela P. Pei", "A. David Paltiel", "Stephen Resch", "Kenneth A. Freedberg", "Trevor Peter", "Rochelle P. Walensky"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001725.g004", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Multi_way_sensitivity_analysis_on_regional_access_to_care_and_linkage_to_care_with_POC_CD4_compared_to_LAB_CD4_/1171351", "title"=>"Multi-way sensitivity analysis on regional access to care and linkage to care with POC-CD4 compared to LAB-CD4.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-09-16 02:51:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/1677832"], "description"=>"a<p>Model output using cited input parameters.</p>b<p>Overall suppression will be lower for second-line ART, as poorly adherent patients are more likely to experience ART failure and initiate second-line ART.</p>c<p>Loss to follow-up includes interruptions in HIV care of at least 12 mo among those HIV-infected patients who are already linked to care and excludes attrition from care due to mortality or transfers to another clinical care site.</p>d<p>Costs of routine HIV care on first-line ART include direct costs for inpatient and outpatient care related to HIV infection, co-trimoxazole prophylaxis, ART when initiated and any toxicity if it occurs, and laboratory CD4 tests for ongoing immunological monitoring. We exclude costs associated with absence from work or transport to clinics, as neither the MMOH nor other funding sources are responsible for such costs.</p><p>3TC, lamivudine; AZT, zidovudine; LPV/r, lopinavir/ritonavir; NVP, nevirapine.</p><p>Model input parameters for analysis of immunological staging by POC-CD4 versus LAB-CD4 in Mozambique.</p>", "links"=>[], "tags"=>["sensitivity analyses", "impact", "survival", "HIV testing", "HIV diagnosis", "linkage", "icer", "mozambique", "YLS", "person lifetime costs", "outcome", "ci", "setting", "parameter"], "article_id"=>1171352, "categories"=>["Uncategorised"], "users"=>["Emily P. Hyle", "Ilesh V. Jani", "Jonathan Lehe", "Amanda E. Su", "Robin Wood", "Jorge Quevedo", "Elena Losina", "Ingrid V. Bassett", "Pamela P. Pei", "A. David Paltiel", "Stephen Resch", "Kenneth A. Freedberg", "Trevor Peter", "Rochelle P. Walensky"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001725.t001", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Model_input_parameters_for_analysis_of_immunological_staging_by_POC_CD4_versus_LAB_CD4_in_Mozambique_/1171352", "title"=>"Model input parameters for analysis of immunological staging by POC-CD4 versus LAB-CD4 in Mozambique.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-09-16 02:51:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/1677827"], "description"=>"<p>In both LAB-CD4 and POC-CD4, literature-based probabilities are shown for: completing a laboratory CD4 test, receiving the test result, and successful initiation of care (<a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001725#pmed-1001725-t001\" target=\"_blank\">Table 1</a>). Probability of linkage depends on ART eligibility as determined by the “true CD4 count,” as well as the “observed CD4 count” test result (T) <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001725#pmed.1001725-Jani2\" target=\"_blank\">[14]</a>. Bolded branches denote where the outcomes result in linkage to care. T+, observed CD4 count ≤250/µl; T−, observed CD4 count>250/µl.</p>", "links"=>[], "tags"=>["sensitivity analyses", "impact", "survival", "HIV testing", "HIV diagnosis", "linkage", "icer", "mozambique", "YLS", "person lifetime costs", "outcome", "ci", "setting", "parameter"], "article_id"=>1171347, "categories"=>["Uncategorised"], "users"=>["Emily P. Hyle", "Ilesh V. Jani", "Jonathan Lehe", "Amanda E. Su", "Robin Wood", "Jorge Quevedo", "Elena Losina", "Ingrid V. Bassett", "Pamela P. Pei", "A. David Paltiel", "Stephen Resch", "Kenneth A. Freedberg", "Trevor Peter", "Rochelle P. Walensky"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001725.g001", "stats"=>{"downloads"=>2, "page_views"=>11, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Schematic_comparing_two_strategies_for_immunological_staging_after_HIV_diagnosis_LAB_CD4_and_POC_CD4_/1171347", "title"=>"Schematic comparing two strategies for immunological staging after HIV diagnosis: LAB-CD4 and POC-CD4.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-09-16 02:51:32"}

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