Journal of acquired immune deficiency syndromes (1999)

1944-788472 Suppl 2Suppl 22016Aug01Journal of acquired immune deficiency syndromes (1999)J Acquir Immune Defic SyndrModeling the Cost-Effectiveness of Home-Based HIV Testing and Education (HOPE) for Pregnant Women and Their Male Partners in Nyanza Province, Kenya.S174S180S174-8010.1097/QAI.0000000000001057Women in sub-Saharan Africa face a 2-fold higher risk of HIV acquisition during pregnancy and postpartum and the majority do not know the HIV status of their male partner. Home-based couple HIV testing for pregnant women can reduce HIV transmission to women and infants while increasing antiretroviral therapy (ART) coverage in men. However, the cost-effectiveness of this program has not been evaluated.We modeled the health and economic impact of implementing a home-based partner education and HIV testing (HOPE) intervention for pregnant women and their male partners in a region of Western Kenya (formally Nyanza Province). We used data from the HOPE randomized clinical trial conducted in Kisumu, Kenya, to parameterize a mathematical model of HIV transmission. We conducted an in-country microcosting of the HOPE intervention (payer perspective) to estimate program costs as well as a lower cost scenario of task-shifting to community health workers.The incremental cost of adding the HOPE intervention to standard antenatal care was $31-37 and $14-16 USD per couple tested with program and task-shifting costs, respectively. At 60% coverage of male partners, HOPE was projected to avert 6987 HIV infections and 2603 deaths in Nyanza province over 10 years with an incremental cost-effectiveness ratio (ICER) of $886 and $615 per disability-adjusted life year averted for the program and task-shifting scenario, respectively. ICERs were robust to changes in intervention coverage, effectiveness, and ART initiation and dropout rates.The HOPE intervention can moderately decrease HIV-associated morbidity and mortality by increasing ART coverage in male partners of pregnant women. ICERs fall below Kenya's per capita gross domestic product ($1358) and are therefore considered cost-effective. Task-shifting to community health workers can increase intervention affordability and feasibility.SharmaMonishaM*Department of Epidemiology, University of Washington, Seattle, WA; †Department of Global Health, University of Washington, Seattle, WA; ‡School of Medicine, University of Washington, Seattle, WA; Departments of §Research and Programs; ‖Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya; ¶Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya; and #Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA.FarquharCareyCYingRogerRKrakowiakDaisyDKinuthiaJohnJOsotiAlfredAAsilaVictorVGoneMollyMMarkJenniferJBarnabasRuanne VRVengK24 AI087399AINIAID NIH HHSUnited StatesK43 TW010363TWFIC NIH HHSUnited StatesR01 HD075108HDNICHD NIH HHSUnited StatesT32 AI007140AINIAID NIH HHSUnited StatesJournal Article