Cost-effectiveness of HIV Monitoring Strategies in Resource-Limited Settings

Abstract

Two-thirds of the world's HIV-infected population resides in Africa, and most of the world's new infections occur in low- and middle-income countries. In the southern cone of Africa, which includes heavily affected countries such as Angola, Botswana, Malawi, Mozambique, Namibia, South Africa, Zambia, and Zimbabwe, approximately 11 million persons are infected with HIV.^1,2 Despite substantial progress in access to treatment, only 20% of adults who need highly active antiretroviral therapy (HAART) receive it.¹ In addition, in many resource-limited regions, the conditions of individuals who receive HAART are managed without access to monitoring of CD4 T-cell counts or human immunodeficiency viral load, which may substantially reduce the effectiveness of HAART.³ Therefore, key questions in the management of HIV infection in resource-constrained settings are whether and how to monitor persons infected with HIV and when to initiate HAART. Little is known about the effectiveness and cost-effectiveness of evaluation and treatment initiation criteria in southern Africa, and monitoring of infected individuals remains a major challenge for clinicians and health care systems.^4,5