Table 1. Summary of base case input parameters and sensitivity analyses ranges examined for an analysis of a mobile HIV testing unit Cape Town, South Africa.
Variable | Base Case | Range | Ref. | |
Baseline cohort characteristics | ||||
Male subjects (%) | 44 | 30–80 | [26] | |
Age, mean years (SD) | 33 (13) | 20–44 | [26] | |
Prevalence of undiagnosed HIV (%) | 6.6 | 1–30 | [26] | |
HIV-infected patients CD4 count at diagnosis (mean cells/µL (SD)) | ||||
Mobile unit testing | Male* | 423 (236) | [26] | |
Female | 516 (272) | [26] | ||
Medical facility-based testing† | Male | 291 (203) | [18], [26] | |
Female | 357 (242) | [18], [26] | ||
HIV screening | ||||
Mobile unit testing characteristics (one-time HIV test and POC CD4 count offer) | ||||
HIV test acceptance probability (%) | Male* | 97 | 70–99 | [26] |
Female | 95 | 70–99 | [26] | |
Initial HIV test (Bioline HIV-1/2 3.0, Standard Diagnostics, South Korea) | [57] | |||
Test sensitivity (%) | 100 | |||
Test specificity† (%) | 99 | |||
Confirmatory HIV test (Determine HIV-1/2, Abbott Laboratories, UK) | [57] | |||
Test sensitivity (%) | 100 | |||
Test specificity† (%) | 100 | |||
CD4 count POC test (Alere PIMA™ Analyzer, Waltham, MA, USA) | ||||
CD4 count acceptance probability (%) | 91 | 70–99 | [26] | |
CD4 >350 cells/µL | Male* | 31 | 20–98 | |
Female | 51 | 20–98 | ||
CD4 201–350 cells/µL | 49 | 20–98 | ||
CD4 <200 cells/µL | 58 | 20–98 | ||
Medical facility-based program average HIV test frequency | [18] † | |||
HIV positive result | Every 4.0 yrs | 1–10 yrs | ||
HIV negative result | Every 5.7 yrs | 1–10 yrs | ||
Loss to follow-up and return to care | ||||
Probability of loss to follow-up | [58], [59] † | |||
Pre-ART (monthly) | 0.0108 | 0.005–0.02 | ||
On ART (monthly) | Adherence >95% | 0.0016 | ||
Adherence <50% | 0.0108 | 0.005–0.02 | ||
Probability of return to care | Assumption | |||
With acute WHO stage 3–4 disease or TB | 0.50 | |||
Without WHO stage 3–4 disease or TB after first year lost (monthly) | 0.01 | 0.005–0.02 | ||
ART treatment | ||||
Initiation at WHO stage 3–4 disease presentation, TB, or CD4 <350/µL | [9], [32] | |||
Monthly CD4 count increase on suppressive ART (cells/µL) | [41] | |||
Initial 8 weeks | 67 | |||
After 8 weeks | 3 | |||
HIV screening costs (2012 US$) | ||||
Mobile testing intervention (2-year) (×1,000) | [26] | |||
Purchase and modification | 152.0 | |||
Mobile van resale value | (56.4) | |||
Medical/counselor salaries‡ | 216.2 | |||
Administrative salaries/maintenance§ | 209.8 | |||
Total 2-year mobile unit intervention cost∥ | 521.6 | 250–1,000 | ||
No. of individuals offered a test over 2-yrs | 18,870 | 9,440–28,310 | ||
Per-person mobile unit cost (excluding HIV test costs) | 27.60 | 13.60–54.40 | ||
Initial HIV test | 1.70 | 0–8.50 | ||
Confirmatory HIV test | 2.00 | |||
Total per-person mobile unit cost (including HIV test costs) | ||||
HIV-negative result | 29.30 | 14.70–44.00 | ||
HIV-positive result | 31.30 | 15.70–46.95 | ||
POC CD4 count | 7.70 | 0–38.00 | ||
Medical facility-based HIV testing programs¶ | [45] | |||
HIV-positive result | 13.90 | |||
HIV-negative result | 9.30 | |||
Clinical care costs (2012 US$) | ||||
Co-trimoxazole prophylaxis cost (monthly) | 1.40 | [34] | ||
ART regimen cost (monthly) | [33] | |||
First-line | 13.30 | |||
Second-line | 40.30 | |||
Laboratory CD4 count test cost | 13.90 | [35] | ||
HIV RNA cost | 69.50 | [35] | ||
Inpatient hospital cost, per day | 315.10 | [35] | ||
Outpatient hospital cost, per visit | 32.60 | [35] |
Statistically significant difference between males and females.
Parameter derived and/or calculated from reference data.
Comprising of one nurse practitioner ($84,200), one registered nurse ($71,100), three counselors ($47,500), one educator ($1,200) and one nurse practitioner at 20% time ($12,200).
Made up of one driver ($27,100), one project manager ($152,300), one data capturer/administrator ($22,000), diesel ($7,500) and general maintenance ($900).
Assumed that van could be resold after 2 years of use.
Costs include initial and confirmatory HIV test, staff salaries, and space in a voluntary counseling and testing site.
SD: standard deviation; POC: point-of-care; ART: antiretroviral therapy; WHO: World Health Organization; TB: tuberculosis.