Journal of Korean Medical Science

  • 제33권46호
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  • Pages.304.1-304.7
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  • 2018
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  • 1011-8934(pISSN)
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  • 1598-6357(eISSN)
대한의학회 (Korean Acad Medical Sciences)
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Cost-Effectiveness of Voluntary HIV Testing Strategies in a Very Low-Prevalence Country, the Republic of Korea

  • Lee, Young Hwa (Department of Epidemiology, Seoul National University Graduate School of Public Health) ;
  • Bang, Ji Hwan (Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Park, Sang Min (Department of Family Medicine, Seoul National University College of Medicine) ;
  • Kang, Cho Ryok (Environmental Health Division, Seoul Metropolitan Government) ;
  • Cho, Sung-Il (Department of Epidemiology, Seoul National University Graduate School of Public Health) ;
  • Oh, Myoung-don (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Lee, Jong-Koo (Department of Family Medicine, Seoul National University College of Medicine)
  • 투고 : 2018.04.25
  • 심사 : 2018.08.16
  • 발행 : 2018.11.12
⟨ 이전 논문 다음 논문 ⟩

초록

Background: The Republic of Korea has a very low prevalence of human immunodeficiency virus (HIV) infection, but the number of new HIV diagnoses has steadily risen, strongly indicating a large number of undetected HIV infections. Thus, it is important for Korean public health authorities to adopt and encourage cost-effective HIV detection tools, such as rapid HIV screening tests. In this study, we aimed to evaluate the cost-effectiveness of enzyme-linked immunosorbent assays (ELISA) and rapid tests in a public health center (PHC) setting. Methods: We developed a decision analytic model to assess the per-examinee cost and the cost-effectiveness of identifying HIV patients in a PHC setting using two HIV testing strategies: conventional HIV screening by ELISA versus rapid HIV testing. Analysis was performed in two scenarios: HIV testing in an average-risk population and in a high-risk population. Results: Compared to the ELISA, the rapid test was cost-saving and cost-effective. The per-examinee cost was USD 1.61 with rapid testing versus USD 3.38 with ELISA in an average-risk population, and USD 4.77 with rapid testing versus USD 7.62 with ELISA in a high-risk population. The cost of identifying a previously undiagnosed HIV case was USD 26,974 with rapid testing versus USD 42,237 with ELISA in an average-risk population, and USD 153 with rapid testing versus USD 183 with ELISA in a high-risk population. Conclusion: Rapid testing would be more cost-effective than using conventional ELISA testing for identifying previously undiagnosed HIV-infected cases in Korea, a country with extremely low HIV prevalence.

키워드

참고문헌

  1. Wang H, Wolock TM, Carter A, Nguyen G, Kyu HH, Gakidou E, et al. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. Lancet HIV 2016;3(8):e361-87. https://doi.org/10.1016/S2352-3018(16)30087-X
  2. Korea Centers for Diseases Control and Prevention. The Status of HIV/AIDS Infection of Korea. Cheongju: Korea Centers for Disease Control and Prevention; 2016.
  3. Joint United Nations Programme on HIV/AIDS. Global AIDS Update 2016. Geneva: UNAIDS; 2016.
  4. Choi JH, Kim S, Park P, Cho KS. HIV/AIDS Notifications in Korea, 2016. Cheongju: Korea Centers for Disease Control and Prevention; 2017.
  5. Kim J, Lee E, Park BJ, Bang JH, Lee JY. Adherence to antiretroviral therapy and factors affecting low medication adherence among incident HIV-infected individuals during 2009-2016: a nationwide study. Sci Rep 2018;8(1):3133. https://doi.org/10.1038/s41598-018-21081-x
  6. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA 2016;316(2):171-81. https://doi.org/10.1001/jama.2016.5148
  7. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med 2016;375(9):830-9. https://doi.org/10.1056/NEJMoa1600693
  8. Bavinton B, Grinsztejn B, Phanuphak N, Jin F, Zablotska I, Prestage G, et al., editors. HIV treatment prevents HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. Proceedings of the 9th International AIDS Society Conference on HIV Science; 2017 July 23-26; Paris, France. Geneva: International AIDS Society; 2017.
  9. Korea Centers for Diseases Control and Prevention. HIV/AIDS Management Guidelines. Cheongju: Korea Centers for Disease Control and Prevention; 2015.
  10. Joint United Nations Programme on HIV/AIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic 2013. Geneva: UNAIDS; 2013.
  11. Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet 2012;380(9839):367-77. https://doi.org/10.1016/S0140-6736(12)60821-6
  12. Farnham PG, Hutchinson AB, Sansom SL, Branson BM. Comparing the costs of HIV screening strategies and technologies in health-care settings. Public Health Rep 2008;123 Suppl 3:51-62. https://doi.org/10.1177/00333549081230S307
  13. U.S. Food and Drug Administration. Package Insert: Genetic Systems HIV-1/HIV-2 Plus O EIA. Silver Spring, MD: U.S. Food and Drug Administration; 2005.
  14. Bulterys M, Jamieson DJ, O'Sullivan MJ, Cohen MH, Maupin R, Nesheim S, et al. Rapid HIV-1 testing during labor: a multicenter study. JAMA 2004;292(2):219-23. https://doi.org/10.1001/jama.292.2.219
  15. Kang CR, Bang JH, Cho SI, Kim KN, Lee HJ, Lee YH, et al. Implementing the use of rapid HIV tests in public health centers in Seoul: results of a pilot project, 2014. J Korean Med Sci 2016;31(3):467-9. https://doi.org/10.3346/jkms.2016.31.3.467
  16. Kowalczyk Mullins TL, Braverman PK, Dorn LD, Kollar LM, Kahn JA. Adolescent preferences for human immunodeficiency virus testing methods and impact of rapid tests on receipt of results. J Adolesc Health 2010;46(2):162-8. https://doi.org/10.1016/j.jadohealth.2009.06.015
  17. San Antonio-Gaddy M, Richardson-Moore A, Burstein GR, Newman DR, Branson BM, Birkhead GS. Rapid HIV antibody testing in the New York State anonymous HIV counseling and testing program: experience from the field. J Acquir Immune Defic Syndr 2006;43(4):446-50. https://doi.org/10.1097/01.qai.0000243055.65698.51
  18. Keenan PA, Keenan JM. Rapid HIV testing in urban outreach: a strategy for improving posttest counseling rates. AIDS Educ Prev 2001;13(6):541-50. https://doi.org/10.1521/aeap.13.6.541.21439
  19. Patel P, Bennett B, Sullivan T, Parker MM, Heffelfinger JD, Sullivan PS, et al. Rapid HIV screening: missed opportunities for HIV diagnosis and prevention. J Clin Virol 2012;54(1):42-7. https://doi.org/10.1016/j.jcv.2012.01.022
  20. Gautheret-Dejean A, Bocobza J, Brunet S, Damond F, Plantier JC, Barin F. Performance of rapid tests for discrimination between HIV-1 and/or HIV-2 infections. J Med Virol 2015;87(12):2061-6. https://doi.org/10.1002/jmv.24282
  21. Gilbert M. Impact and Use of Point of Care HIV Testing: a Public Health Evidence Paper. Vancouver, BC: BC Centre for Disease Control; 2007.
  22. World Health Organization. HIV Assays: Operational Characteristics. Report 14. Simple/rapid Tests. Geneva: World Health Organization; 2004.

피인용 문헌

  1. Rapid HIV test more cost effective than ELISA in Korea vol.817, pp.1, 2018, https://doi.org/10.1007/s40274-018-5484-z
  2. Clinical profiles of early and tuberculosis-related mortality in South Korea between 2015 and 2017: a cross-sectional study vol.19, pp.1, 2018, https://doi.org/10.1186/s12879-019-4365-9