Table 2.

Key outcomes of simulated strategies.

Outcome	Clinical monitoring Adherence scenario:		CD4 monitoring Adherence scenario:		POC viral load monitoring LOD (copies/ml):
	A/B	C	A/B	C	125	400	1000	5000	10000
Monitoring
Unnecessary switches to second-line ART (per 100 patients)	9	7	5	5	15	8	5	3	2
Missed true treatment failure (per 100 failures)	76	77	37	36	5	5	5	5	6
Life expectancy at start of ART (QALYs)
Mean quality-adjusted life years	12.78	12.60	12.89	12.80	12.93	12.93	12.93	12.93	12.93
Costs (US$ per person)
Appointments	577	569	582	577	583	583	584	584	583
Diagnostic tests	0	0	159	159	476–952*	470–941*	234–935**	232–928**	231–926**
First-line ART	2004	1952	1940	1800	1698	1799	1838	1865	1873
Second-line ART	456	527	720	1117	1506	1187	1066	977	951
Total costs of ART	3037	3047	3400	3654	4263–4739*	4038–4510*	3721–4422**	3658–4354**	3639–4334**
HIV transmission (per 100 patients)
New infections	7.1	11.1	5.7	9.3	4.3	4.0	3.9	3.9	4.0
QALYs lost	22.6	32.3	20.2	29.2	15.5	14.9	14.7	14.7	15.0
Costs in US$	14500	20600	12900	18700	9900	9500	9400	9400	9600

Each simulation is based on 10 000 patients starting antiretroviral therapy, followed up until death.

QALY, quality-adjusted life years

Adherence scenario A/B: Risk of virologic failure is equal in all monitoring strategies

Adherence scenario C: Risk of virologic failure is twice as high with clinical and CD4 monitoring compared to viral load monitoring

^*Depending on unit cost of viral load test, ranging from $10 to $20

^**Depending on unit cost of viral load test, ranging from $5 to $20

POC, point-of-care; LOD, limit of detection; ART, antiretroviral therapy; QALY, quality-adjusted life year