Table 1.
Selected model input values for an analysis of 90-90-90 in South Africa
| Cohort | Mean Age (SD), years | Mean CD4 (SD), × 109 cells/L* | Weighted Distribution, % | Reference |
|---|---|---|---|---|
| Incident | 30 (8) | 0.667 (0.134) | N/A | (7,8) |
| Prevalent undiagnosed | 36 (16) | 0.434 (0.255) | 45.3 | (2,22) |
| Prevalent, on first-line ART | 39 (16) | 0.454 (0.246) | 31.8 | (2,22) |
| Prevalent, on second-line ART | 41 (16) | 0.454 (0.246) | 1.7 | (2,4,22) |
| Prevalent diagnosed, not in care | 41 (16) | 0.257 (0.080) | 21.2 | (2,9,22) |
| Cohort Characteristics | Value | Reference |
|---|---|---|
| Gender distribution, % male | 42.3 | (22) |
| HIV RNA distribution after acute infection, % | (17) | |
| >100,000 copies/ml | 42 | |
| 30,001–100,000 copies/ml | 28 | |
| 10,001–30,000 copies/ml | 18 | |
| 3,001–10,000 copies/ml | 8 | |
| ≤3,000 copies/ml | 4 | |
| Mean ART efficacy, % virologic suppression at 48 weeks | 72 | (2,10) |
| Loss to follow-up, probability in care at 5 (1) years, % | (12–14) | |
| Current Pace strategy | 80 (96) | |
| UNAIDS Target strategy | 88 (98) | |
| Return to care | ||
| Return to care probability after one year monthly % | 1.0 | Assumption |
| Return to care probability upon WHO stage 3/4 OI, % | 50 | Assumption |
| Transmission rates (per 100PY), by disease stage and viral load | (15,16) | |
| Incident infection (6 months post infection) | 7.25 × 9.03† | |
| Late stage disease (CD4 <2.00 × 109 cells/L) | 9.03 | |
| >100,000 copies/ml | 9.03 | |
| 10,001–100,000 copies/ml | 8.12 | |
| 3,001–10,000 copies/ml | 4.17 | |
| 501–3,000 copies/ml | 2.06 | |
| 21–500 copies/ml | 0.16 | |
| ≤20 copies/ml | 0.16 | |
|
| ||
|
Orphans
| ||
| HIV-specific age-stratified fertility rates (per 100PY)‡ | (20,22,23) | |
| 15–19 years | 5.8 | |
| 20–29 years | 9.1 | |
| 30–39 years | 6.6 | |
| 40–49 years | 1.0 | |
|
| ||
|
Costs, 2014 USD
| ||
| ART Costs | (25) | |
| First-line ART, monthly (annually) | 11 (137) | |
| Second-line ART, monthly (annually) | 31 (375) | |
| Monitoring costs | (30) | |
| HIV viral load, cost per test | 36 | |
| CD4 count, cost per test | 7 | |
| Routine care cost, monthly (ranges by CD4 count) | (26,30) | |
| CD4 > 0.500 × 109 cells/L | 20 | |
| CD4 0.350 – 0.500 × 109 cells/L | 27 | |
| CD4 0.200 – 0.350 × 109 cells/L | 32 | |
| CD4 0.050 – 0.200 × 109 cells/L | 70 | |
| CD4 < 0.050 × 109 cells/L | 157 | |
| OI treatment costs (ranges by OI) | (27) | |
| WHO stage 3–4 AIDS defining diseases | ||
| Visceral | 810 | |
| Muco-cutaneous | 520 | |
| Other | 430 | |
| Tuberculosis | 770 | |
| Severe Bacterial infections | 770 | |
| Mild fungal disease | 360 | |
| Mild other disease | 240 | |
| UNAIDS Target Strategy only | (31) | |
| HIV test cost per negative test | 7 | |
| HIV test cost per positive test | 20 | |
| Adherence/retention intervention cost, annual per patient on ART§ | 155 | |
Abbreviations: SD, standard deviation; ART, antiretroviral therapy; PY, person years; OI, opportunistic infection; WHO, World Health organization; USD, United States Dollars
When reported as medians and interquartile ranges, CD4 cell counts were converted to means and standard deviations for reporting purposes.
During the period of acute infection, the transmission rate is 7.25 times the transmission rate of the highest viral load stratum (>100,000 copies/mL).
Using age-specific HIV prevalence as well as age-specific fertility rate risk ratios between HIV-infected and uninfected, we derived HIV- and age-specific fertility rates. These rates/100PY translate into a total fertility rate (TFR) for HIV-infected: 2.0, TFR for HIV-uninfected: 2.7 (20, 22, 23)
Adherence/retention intervention affects ART efficacy (% suppressed) and attenuates loss to follow-up as described in the Methods.