title: Projecting the epidemiological effect, cost-effectiveness and transmission of HIV drug resistance in Vietnam associated with viral load monitoring strategies.
abstract: OBJECTIVE
  The objective of this study was to investigate the potential epidemiological impact of viral load (VL) monitoring and its cost-effectiveness in Vietnam, where transmitted HIV drug resistance (TDR) prevalence has increased from <5% to 5%-15% in the past decade.
  
  
  METHODS
  Using a population-based mathematical model driven by data from Vietnam, we simulated scenarios of various combinations of VL testing coverage, VL thresholds for second-line ART initiation and availability of HIV drug-resistance tests. We assessed the cost per disability-adjusted life year (DALY) averted for each scenario.
  
  
  RESULTS
  Projecting expected ART scale-up levels, to approximately double the number of people on ART by 2030, will lead to an estimated 18 510 cases (95% CI: 9120-34 600 cases) of TDR and 55 180 cases (95% CI: 40 540-65 900 cases) of acquired drug resistance (ADR) in the absence of VL monitoring. This projection corresponds to a TDR prevalence of 16% (95% CI: 11%-24%) and ADR of 18% (95% CI: 15%-20%). Annual or biennial VL monitoring with 30% coverage is expected to relieve 12%-31% of TDR (2260-5860 cases), 25%-59% of ADR (9620-22 650 cases), 2%-6% of HIV-related deaths (360-880 cases) and 19 270-51 400 DALYs during 2015-30. The 30% coverage of VL monitoring is estimated to cost US$4848-5154 per DALY averted. The projected additional cost for implementing this strategy is US$105-268 million over 2015-30.
  
  
  CONCLUSIONS
  Our study suggests that a programmatically achievable 30% coverage of VL monitoring can have considerable benefits for individuals and leads to population health benefits by reducing the overall national burden of HIV drug resistance. It is marginally cost-effective according to common willingness-to-pay thresholds.
authors: Disease Modelling and Financing Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam.
authors: Quang Duy
authors: QD
authors: Pham
authors: Disease Modelling and Financing Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors: David P
authors: DP
authors: Wilson
authors: Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam.
authors: Thuong Vu
authors: TV
authors: Nguyen
authors: Department of HIV Care and Treatment, Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam.
authors: Nhan Thi
authors: NT
authors: Do
authors: Department of Laboratory Analysis, Pasteur Institute, Ho Chi Minh City, Vietnam.
authors: Lien Xuan
authors: LX
authors: Truong
authors: Ministry of Health, Hanoi, Vietnam.
authors: Long Thanh
authors: LT
authors: Nguyen
authors: Disease Modelling and Financing Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Research Center for Public Health, School of Medicine, Tsinghua University, China Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia lzhang@kirby.unsw.edu.au.
authors: Lei
authors: L
authors: Zhang
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016903:Drug Monitoring / Q000191:economics* / Q000379:methods; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D011446:Prospective Studies; D014744:Vietnam / Q000453:epidemiology; D019562:Viral Load / Q000191:economics* / Q000379:methods
chemical_list: D000998:Antiviral Agents