Table 2 Costs of early infant HIV diagnosis interventions and programs
Intervention | Total reported cost of intervention (USD) | Currency of reported cost | Total converted cost of intervention (USD 2021) | Description | Setting | Source(s) |
|---|---|---|---|---|---|---|
Testing strategies—per person costs | ||||||
NAT (lab) at birth + 6 weeks | 870/HIV-exposed infant | 2013 USD | 1012 | Discounted cost/infant including EID, ART, routine care and monitoring, opportunistic infections, and death | South Africa | Franke et al. [24] |
NAT (lab) at 6Â weeks only | 820/HIV-exposed infant | 954 | ||||
Birth + 6-week EID testing | 1379/HIV-exposed infant | USD, year not specified | 1632 | Cost per HIV-infected diagnosis | South Africa | Collins et al. [59] |
6-week EID testing only | 458/HIV-exposed infant | 542 | ||||
Total incremental cost of adding NAT at birtha | 8060/HIV-infected diagnosis | 2015 USD | 9114 | Cost (clinical labor, drugs, supplies, commodities, support staff, construction and renovation, equipment, sample transport) per early infection identified and started on ART | Lesotho | Tchuenche et al. [44] |
PoC EID (GeneXpert Gel) | 240/HIV-exposed infant | 2017 USD | 264 | Discounted HIV-related lifetime costs including PoC strategy costs, HIV care, and ART | Zimbabwe | McCann et al. [51] |
PoC EID (platform not specified) | 420/HIV-exposed infant | 2016 USD | 470 | Discounted EID testing costs for 6-week testing, HIV-related lifetime costs including HIV care, CD4 test, VL test, ART regimen costs | Zimbabwe | Frank et al. [52] |
Strengthened laboratory-based EID (S-LAB) | 222/HIV-exposed infant | 2017 USD | 244 | Discounted HIV-related lifetime costs including HIV care, strengthened laboratory-based strategy costs, and ART | Zimbabwe | McCann et al. [51] |
Testing at 6Â weeks, with confirmatory testing | 1790/HIV-exposed infant tested | 2013 USD | 2082 | Lifetime cost per HIV-exposed infant including cost of NAT and return of results, routine HIV care, ART, opportunistic infection care, and major toxicity events | South Africa | Dunning et al. [54] |
Testing at 6Â weeks, without confirmatory testing | 1830/HIV-exposed infant tested | 2129 | ||||
Universal maternal HIV screening at infant immunization visits with referral to EID | 1. 60/mother-infant pair 2. 180/mother-infant pair 3. 100/mother-infant pair | 2018 USD | 1. 64 2. 193 3. 107 | Screen-and-test per-person lifetime costs including maternal HIV screening, infant NAT, routine HIV care, acute OI care, and pediatric ART | 1. Cote d'Ivoire 2. South Africa 3. Zimbabwe | Dunning et al. [57] |
Initial rapid RHT testing to screen-out HIV-uninfected infants before DNA-rtPCR | 147 (average cost per HIV positive infant correctly diagnosed and informed of result) | 2007 USD | 188 | Testing activity costs including personnel and supplies for pre-test counseling, sample collection and preparation, rapid HIV testing, DNA-PCR testing, and post-test counseling | Uganda | Menzies et al. [41] |
Testing strategies—per population costs | ||||||
PoC testing (m-PIMA) including confirmatory test | 4,246,527 (total program costs) | 2018 USD | 4,556,354 | Capital costs including platform purchase, installation, insurance, and maintenance, sample transport, and training. Recurrent costs including reagents, blood collection supplies, and staff time for testing up to three times (birth, 6Â weeks, and 6Â months | Zambia | De Broucker et al. [53] |
PoC testing (GeneXpert) including confirmatory test | 2,851,894 (total program costs) | 3,059,969 | ||||
PoC testing (m-PIMA) with confirmatory testing in central laboratory | 4,339,757 (total program costs) | 4,656,387 | ||||
PoC testing (GeneXpert) with confirmatory testing in central laboratory | 2,945,768 (total program costs) | 3,160,692 | ||||
PoC testing (m-PIMA) 1. Low PMTCT setting 2. High PMTCT setting | Total EID program costs 1. 1,818,000 2. 1,801,000 | 2018 USD | 1. 1,950,642 2. 1,932,401 | Capital costs including service and maintenance, freight, insurance, inspection, handling, and customer service delivery. Recurrent costs including reagents, consumables, sample collection, transport, and waste management | sub-Saharan Africa | Salvatore et al. [50] |
PoC testing (GeneXpert) 1. Low PMTCT setting 2. High PMTCT setting | Total EID program costs 1. 1,662,000 2. 1,647,000 | 1. 1,783,260 2. 1,767,166 | ||||
PoC testing (GeneXpert) Edge 1. Low PMTCT setting 2. High PMTCT setting | Total EID program costs 1. 1,148,000 2. 1,134,000 | 1. 1,231,758 2. 1,216,737 | ||||
PoC (m-PIMA) + centralized testing 1. Low PMTCT setting 2. High PMTCT setting | Total EID program costs 1. 1,818,000 2. 1,802,000 | 1. 1,950,642 2. 1,933,474 | ||||
PoC (GeneXpert) + centralized testing 1. Low PMTCT setting 2. High PMTCT setting | Total EID program costs 1. 1,662,000 2. 1,648,000 | 1. 1,783,260 2. 1,768,238 | ||||
PoC (GeneXpert Edge) + centralized testing 1. Low PMTCT setting 2. High PMTCT setting | Total EID program costs 1. 1,148,000 2. 1,134,000 | 1. 1,231,758 2. 1,216,737 | ||||
PoC (GeneXpert) | 31,695 total implementation cost | 2019 USD | 33,410 | Infrastructure, PoC testing, maintenance and repairs during study, training, labor including travel and accommodation | Rural Zambia | Sutcliffe et al. [45] |
Other interventions | ||||||
Sample transfer model | 1. 20–40 2. 4,244,000 | USD, year not specified | 1. 23.27–46.53 2. 5,117,496 | Sample transfer per batch Not listed | 1. Nigeria 2. Uganda | 1. Ndulue et al. [60] 2. Kiyaga et al. [22] |
1. Single well-equipped and staffed lab for EID 2. Four-lab EID system 3. Eight-lab EID system | Total cost not listed, see description | USD, year not specified | N/A | 1. Reagents (5,076,035), consumables (122,276), DBS collection supplies (1,015,834), transport to districts (476,024), recurrent costs (2,821,761) 2. Reagents (5,076,035), consumables (122,276), DBS collection supplies (1,015,834), transport to districts (457,944), recurrent costs (4,593,200) 3. Reagents (3,893,435), consumables (923,510), DBS collection supplies (1,015,834), transport to districts (433,844), recurrent costs (6,960,344) | Uganda | Kiyaga et al. [61] |
Expedited results system (ERS) with GPRS | 0.0002/result transmitted | USD, year not specified | 0.0003 | Cost of transmitting each result using GPRS technology | Mozambique | Jani et al. [23] |
HITSystem (infant tracking system) | Total cost not listed, see description | USD, year not specified | N/A | 1. Direct implementation costs/month/hospital (mobile broadband minutes, patient tracing, texting, data storage): 350. One-time start-up costs/hospital (training, quality assurance, computer and modem purchase): 100–400 2. Fixed monthly costs include a 200 SMS and secure data storage fee and ~ 50 for mobile broadband minutes | Kenya | 1. Finocchiaro-Kessler et al. [62] 2. Finocchiaro-Kessler et al. [63] |
Mobile phone follow-up for EID services | 0.76 | USD, year not specified | 0.94 | Average cost per HIV-exposed infant returned to care | Uganda | Kiyaga et al. [20] |
Quality assurance system (QAS) | Kenya: 208,532/year South Africa: 69,359/year Senegal: 102,853/year Uganda: 203,330/year Zimbabwe: 334,342/year | 2016 USD | Kenya: 233,432/year South Africa: 77,641/year Senegal: 115,134/year Uganda: 227,609/year Zimbabwe: 374,265/year | Total and average annual quality assurance system costs including start-up costs, capital costs, recurrent costs including a 10% wastage rate for supplies, and corrective action costs | Kenya, Senegal, South Africa, Uganda, Zimbabwe | Terris-Prestholt et al. [43] |
Centralized EID with deferred ART based on immune/clinical criteria | 5,254,683/all children | 2011 USD | 6,336,196 | Pre and post HIV test counselling, HIV diagnosis, ART | Thailand | Collins et al. [38] |
Centralized EID with immediate ART | 6,773,115/all children | 8,167,151 | ||||
Co-located MCH care throughout breastfeeding | 14,674/HIV-infected infant | 2016 USD | 16,426 | Lifetime cost for all HIV-infected children in this system | South Africa | Dugdale et al. [27] |
Separate ART services for mothers and infants, referral post-delivery | 14,617/HIV-infected infant | 16,362 | ||||
Neonatal HIV care (Nevirapine + DNA-PCR at 6 weeks) | 90.09/HIV-exposed infant | 2017 USD | 98.98 | DNA-PCR, other supplies, utilities, Nevirapine, capital costs including building, equipment, and training, | Tanzania | Vyas et al. [46] |
EID program (testing approach unspecified) | 1. 60.92/infant tested 2. 10.91/infant tested | 2009 USD | 1. 75.89 2. 13.59 | Nurse, laboratory technician, driver, reagents, miscellaneous items | 1. Namibia 2. Rwanda | Touré et al. [42] |
EID services (not specified) | 1. 28.04/PPY HIV-exposed infant 2. 12.08/PPY HIV-exposed infant | 2014 USD | 1. 32.02 2. 13.79 | Not specified | Ethiopia | Zegeye et al. [47] |