Table 3.

Distribution of annual discounted costs per person for five different policy options, over 15 years from t0 (2017 to 2032)

	Current policy	bPI as first-line regimen*	Pre-ART resistance testing†	Viral load monitoring‡	Single viral load test at 6 months§
ART	9·43	13·60	10·09	9·85	9·71
CD4 cell count	0·83	0·87	0·85	0·12	0·81
Viral load	0	0	0	2·22	0·24
Resistance test	0	0	1·22	0	0
Treatment for WHO stage 4 conditions	1·26	1·16	1·21	1·20	1·23
TB treatment	0·41	0·38	0·39	0·38	0·40
Treatment for WHO stage 3 conditions	0·47	0·43	0·45	0·44	0·46
Co-trimoxazole	0·15	0·14	0·14	0·16	0·15
HIV testing	3·38	3·37	3·38	3·38	3·38
Clinic visits	5·17	5·24	5·20	5·23	5·21
Total	21·1	25·2	22·9	23·0	21·6

Data are mean discounted costs (US$) per adult aged 15–65 years in the population (including both HIV-positive and HIV-negative people) per year. Results are based on 5000 programmatic scenarios. Facility costs are apportioned to resource inputs. Full unit costs are provided in the appendix (p 13). ART=antiretroviral therapy. bPI=boosted protease inhibitor. NNRTI=non-nucleoside reverse transcriptase inhibitor. NRTI=nucleoside reverse transcriptase inhibitor.

^*Change of the standard NNRTI-based regimen to a bPI-based first-line regimen.

^†Individual-level resistance testing before ART initiation to detect key NNRTI mutations to inform whether use of an NNRTI-based or bPI-based regimen is optimum as first-line treatment.

^‡Introduction of routine (6 month, 12 month, then annual) viral load monitoring, replacing 6 monthly CD4 cell count monitoring.

^§A single routine measurement of viral load 6 months after start of ART, with routine CD4 cell count monitoring. In this last scenario, if viral load is >1000 copies per mL, the test is repeated 6 months later; if viral load remains at >1000 copies per mL, a switch to second-line treatment is effected.