title: Modeling the Cost-Effectiveness of Home-Based HIV Testing and Education (HOPE) for Pregnant Women and Their Male Partners in Nyanza Province, Kenya.
abstract: Women in sub-Saharan Africa face a 2-fold higher risk of HIV acquisition during pregnancy and postpartum and the majority do not know the HIV status of their male partner. Home-based couple HIV testing for pregnant women can reduce HIV transmission to women and infants while increasing antiretroviral therapy (ART) coverage in men. However, the cost-effectiveness of this program has not been evaluated.
  
  
  
  We modeled the health and economic impact of implementing a home-based partner education and HIV testing (HOPE) intervention for pregnant women and their male partners in a region of Western Kenya (formally Nyanza Province). We used data from the HOPE randomized clinical trial conducted in Kisumu, Kenya, to parameterize a mathematical model of HIV transmission. We conducted an in-country microcosting of the HOPE intervention (payer perspective) to estimate program costs as well as a lower cost scenario of task-shifting to community health workers.
  
  
  
  The incremental cost of adding the HOPE intervention to standard antenatal care was $31-37 and $14-16 USD per couple tested with program and task-shifting costs, respectively. At 60% coverage of male partners, HOPE was projected to avert 6987 HIV infections and 2603 deaths in Nyanza province over 10 years with an incremental cost-effectiveness ratio (ICER) of $886 and $615 per disability-adjusted life year averted for the program and task-shifting scenario, respectively. ICERs were robust to changes in intervention coverage, effectiveness, and ART initiation and dropout rates.
  
  
  
  The HOPE intervention can moderately decrease HIV-associated morbidity and mortality by increasing ART coverage in male partners of pregnant women. ICERs fall below Kenya's per capita gross domestic product ($1358) and are therefore considered cost-effective. Task-shifting to community health workers can increase intervention affordability and feasibility.
authors.affiliation: *Department of Epidemiology, University of Washington, Seattle, WA; †Department of Global Health, University of Washington, Seattle, WA; ‡School of Medicine, University of Washington, Seattle, WA; Departments of §Research and Programs; ‖Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya; ¶Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya; and #Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Monisha
authors.initials: M
authors.lastname: Sharma
authors.forename: Carey
authors.initials: C
authors.lastname: Farquhar
authors.forename: Roger
authors.initials: R
authors.lastname: Ying
authors.forename: Daisy
authors.initials: D
authors.lastname: Krakowiak
authors.forename: John
authors.initials: J
authors.lastname: Kinuthia
authors.forename: Alfred
authors.initials: A
authors.lastname: Osoti
authors.forename: Victor
authors.initials: V
authors.lastname: Asila
authors.forename: Molly
authors.initials: M
authors.lastname: Gone
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mark
authors.forename: Ruanne V
authors.initials: RV
authors.lastname: Barnabas
mesh_terms: D015492:AIDS Serodiagnosis / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control / Q000635:transmission; D006699:Home Care Services; D006801:Humans; D007630:Kenya; D008297:Male; D018803:Models, Economic; D010353:Patient Education as Topic; D011247:Pregnancy; D012747:Sexual Partners