title: Cost-Effectiveness of the 'One4All' HIV Linkage Intervention in Guangxi Zhuang Autonomous Region, China.
abstract: BACKGROUND
  In Guangxi Zhuang Autonomous Region, China, an estimated 80% of newly-identified antiretroviral therapy (ART)-eligible patients are not engaged in ART. Delayed ART uptake ultimately translates into high rates of HIV morbidity, mortality, and transmission. To enhance HIV testing receipt and subsequent treatment uptake in Guangxi, the Chinese Center for Disease Control and Prevention (CDC) executed a cluster-randomized trial to assess the effectiveness and cost-effectiveness of a streamlined HIV testing algorithm (the One4All intervention) in 12 county-level hospitals.
  
  
  OBJECTIVE
  To determine the incremental cost-effectiveness of the One4All intervention delivered at county hospitals in Guangxi, China, compared to the current standard of care (SOC).
  
  
  CONCLUSIONS
  Health System.
  
  
  METHODS
  1-, 5-and 25-years.
  
  
  METHODS
  We adapted a dynamic, compartmental HIV transmission model to simulate HIV transmission and progression in Guangxi, China and identify the economic impact and health benefits of implementing the One4All intervention in all Guangxi hospitals. The One4All intervention algorithm entails rapid point-of-care HIV screening, CD4 and viral load testing of individuals presenting for HIV screening, with same-day results and linkage to counselling. We populated the model with data from the One4All trial (CTN-0056), China CDC HIV registry and published reports. Model outcomes were HIV incidence, mortality, costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) of the One4All intervention compared to SOC.
  
  
  RESULTS
  The One4All testing intervention was more costly than SOC (CNY 2,182 vs. CNY 846), but facilitated earlier ART access, resulting in delayed disease progression and mortality. Over a 25-year time horizon, we estimated that introducing One4All in Guangxi would result in 802 averted HIV cases and 1629 averted deaths at an ICER of CNY 11,678 per QALY gained. Sensitivity analysis revealed that One4All remained cost-effective at even minimal levels of effectiveness. Results were robust to changes to a range of parameters characterizing the HIV epidemic over time.
  
  
  CONCLUSIONS
  The One4All HIV testing strategy was highly cost-effective by WHO standards, and should be prioritized for widespread implementation in Guangxi, China. Integrating the intervention within a broader combination prevention strategy would enhance the public health response to HIV/AIDS in Guangxi.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.|Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zang
authors.affiliation: The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Houlin
authors.initials: H
authors.lastname: Tang
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Min
authors.affiliation: The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Diane
authors.initials: D
authors.lastname: Gu
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.|Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.affiliation: The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.|Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D002681:China; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D015497:HIV-1 / Q000187:drug effects*; D017048:Health Care Costs; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010342:Patient Acceptance of Health Care; D019095:Point-of-Care Systems; D019057:Quality-Adjusted Life Years; D055815:Young Adult