Research in context
Evidence before this study
Although WHO recommends HIV testing at age 6 weeks for all HIV-exposed infants, less than 50% of these infants worldwide have access to early infant HIV testing. New point-of-care (POC) assays for early infant HIV diagnosis are costlier than conventional total nucleic acid assays, but might increase access to diagnostic results, shorten time to return of results, and expedite initiation of antiretroviral therapy. Although trials and implementation studies have shown operational improvements in, and clinical benefits of, POC testing, the cost-effectiveness of these novel assays compared with conventional assays remains largely unknown. We searched PubMed by combining the search terms “point-of-care” and “early infant HIV diagnosis” with health economic terms (“cost-effectiveness”, “cost benefit”, and “ICER”) for studies published in English from inception up to Sept 25, 2018. We did not identify any studies in which the cost-effectiveness of POC and conventional early infant HIV testing were compared.
Added value of this study
We report the first cost-effectiveness modelling study informed by real-world data from a large-scale implementation initiative of POC early infant HIV diagnosis in Zimbabwe. We include testing costs from the Global Fund to Fight AIDS, Tuberculosis and Malaria to reflect real-time price-breakpoint negotiations and resource-utilisation data for early infant HIV testing from Unitaid and the Elizabeth Glaser Pediatric AIDS Foundation. We present novel outcomes, including projected survival over time, life expectancy, lifetime per-person costs, and cost-effectiveness, for POC testing for early infant HIV diagnosis.
Implications of all the available evidence
Incorporation of POC assays into early infant HIV diagnosis programmes at age 6 weeks in Zimbabwe will improve survival, extend life expectancy, and be cost-effective compared with conventional early infant HIV diagnosis. Results were robust across a wide range of sensitivity analyses, suggesting that they might be largely generalisable to other sub-Saharan African countries. Policy makers should incorporate POC assays into early infant HIV diagnosis programmes to optimise outcomes along the care cascade and thereby improve clinical outcomes for infants.