HIV Treatment in Resource-Limited Environments: Treatment Coverage and Insights
Author
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Khademi, Amin
Author
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Sauré Valenzuela, Denis
Author
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Schaefer, Andrew
Author
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Nucifora, Kimberly
Author
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Braithwaite, Scott
Author
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Roberts, Mark S.
Admission date
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2016-05-15T01:21:40Z
Available date
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2016-05-15T01:21:40Z
Publication date
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2015
Cita de ítem
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Value in Health Volumen18 (2015) 1113 – 1119
en_US
Identifier
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DOI: 10.1016/j.jval.2015.10.003
Identifier
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https://repositorio.uchile.cl/handle/2250/138307
General note
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Artículo de publicación ISI
en_US
Abstract
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Background: The effects of antiretroviral treatment on the HIV epidemic are complex. HIV-infected individuals survive longer with treatment, but are less likely to transmit the disease. The standard coverage measure improves with the deaths of untreated individuals and does not consider the fact that some individuals may acquire the disease and die before receiving treatment, making it susceptible to overestimating the long-run performance of antiretroviral treatment programs. Objective: The objective was to propose an alternative coverage definition to better measure the long-run performance of HIV treatment programs. Methods: We introduced cumulative incidence-based coverage as an alternative to measure an HIV treatment program's success. To numerically compare the definitions, we extended a simulation model of HIV disease and treatment to represent a dynamic population that includes uninfected and HIV-infected individuals. Also, we estimated the additional resources required to implement various treatment policies in a resource-limited setting. Results: In a synthetic population of 600,000 people of which 44,000 (7.6%) are infected, and eligible for treatment with a CD4 count of less than 500 cells/mm(3), assuming a World Health Organization (WHO)-defined coverage rate of 50% of eligible people, and treating these individuals with a single treatment regimen, the gap between the current WHO coverage definition and our proposed one is as much as 16% over a 10-year planning horizon. Conclusions: Cumulative incidence-based definition of coverage yields a more accurate representation of the long-run treatment success and along with the WHO and other definitions of coverage provides a better understanding of the HIV treatment progress.