title: Are long-lasting insecticide-treated bednets and water filters cost-effective tools for delaying HIV disease progression in Kenya?
abstract: BACKGROUND
  Co-infection with malaria and other infectious diseases has been shown to increase viral load and accelerate HIV disease progression. A recent study in Kenya demonstrated that providing long-lasting insecticide-treated bednets (LLIN) and water filters (WF) to HIV-positive adults with CD4 >350 cells/mm(3) significantly reduced HIV progression.
  
  
  METHODS
  We conducted a cost analysis to estimate the potential net financial savings gained by delaying HIV progression and increasing the time to antiretroviral therapy (ART) eligibility through delivering LLIN and WF to 10% of HIV-positive adults with CD4 >350 cells/mm(3) in Kenya.
  
  
  RESULTS
  Given a 3-year duration of intervention benefit, intervention unit cost of US$32 and patient-year ART cost of US$757 (2011 US$), over the lifetime of ART patients, in Kenya, we estimated the intervention could yield a return on investment (ROI) of 11 (95% uncertainty range [UR]: 5-23), based on a cost of about US$2 million and savings in ART costs of about US$26 million (95% UR: 8-50) (discounted at 3%). Our findings were subjected to a number of sensitivity analyses. Of note, deferral of time to ART eligibility could potentially result in 3,000 new HIV infections not averted by ART and thus decrease ART cost savings to US$14 million, decreasing the ROI to 6.
  
  
  CONCLUSIONS
  Provision of LLIN and WF could be a cost-saving and practical method to defer time to ART eligibility in the context of highly resource-constrained environments experiencing donor fatigue for HIV/AIDS programs.
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; verguet@hsph.harvard.edu.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Verguet
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.|Global Health Sciences, University of California, San Francisco, CA, USA.|Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Kahn
authors.affiliation: Health Strategies International, Oakland, CA, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Marseille
authors.affiliation: Health Strategies International, Arlington, VA, USA.
authors.forename: Aliya
authors.initials: A
authors.lastname: Jiwani
authors.affiliation: Assessment, Policy Development & Evaluation, Public Health-Seattle & King County, WA, USA.
authors.forename: Eli
authors.initials: E
authors.lastname: Kern
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA.|Department of Medicine, University of Washington, Seattle, WA, USA.|Department of Pediatrics, University of Washington, Seattle, WA, USA.|Department of Epidemiology, University of Washington, Seattle, WA, USA.|Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Judd L
authors.initials: JL
authors.lastname: Walson
mesh_terms: D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000453:epidemiology*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000191:economics*; D007630:Kenya; D008288:Malaria / Q000517:prevention & control*; D017059:Models, Econometric; D015203:Reproducibility of Results; D019562:Viral Load; D014881:Water Supply / Q000191:economics* / Q000379:methods*
keywords: HIV disease progression; Kenya; antiretroviral therapy; cost savings; diarrhea; insecticide-treated bednets; malaria; sub-Saharan Africa; water filtration