Cost-effectiveness of provider-based HIV partner notification in urban Malawi

摘要: Provider-initiated partner notification for HIV effectively identifies new cases of in sub-Saharan Africa, but is not widely implemented. Our objective was to determine whether provider-based strategies are cost-effective preventing transmission compared with passive referral. We conducted a cost-effectiveness analysis using decision-analytic model from the health system perspective during 1-year period. Costs and outcomes all were estimated decision-tree model. The study setting an urban sexually transmitted infection clinic Lilongwe, Malawi, hypothetical cohort 5000 sex partners 3500 HIV-positive index cases. evaluated three strategies: provider (provider attempts notify indexes’ locatable partners), contract (index given 1 week then notification) referral encouraged partners, standard care). main included cost (US dollars) per averted, case identified tested. Based on transmissions 5000-person cohort, averted 27.9 27.5 infections, respectively, incremental ratio (ICER) $3560 Provider more expensive slightly effective than notification, yielding ICER $51 421 averted. ICERs sensitive proportion contacted, likely positive probability if antiretroviral therapy. costs $36 (provider), $18 (contract) $8 (passive). tested $19 $9 $4 conclude that, this population, potentially identifying HIV. These offer simple, easily implementable opportunity control transmission.