Cost-effectiveness of preventing loss to follow-up in HIV treatment programs: A Côte d'Ivoire appraisal

Elena Losina, Hapsatou Touré, Lauren M. Uhler, Xavier Anglaret, A. David Paltiel, Eric Balestre, Rochelle P. Walensky, Eugène Messou, Milton C. Weinstein, François Dabis, Kenneth A. Freedberg, Melissa Bender, John Chiosi, Jennifer Chu, Sarah Chung, Andrea Ciaranello, Mariam O. Fofana, Heather E. Hsu, Zhigang Lu, Bethany MorrisBrandon Morris, Erin Rhode, Caroline Sloan, Callie A. Scott, Lauren Uhler, Kara Cotich, Sue J. Goldie, April D. Kimmel, Marc Lipsitch, Chara Rydzak, George R. Seage, Yazdan Yazdanpanah, Roger Salamon, Christine Danel, Thérèse N'Dri-Yoman, Raoul Moh, Eric Ouattara, Siaka Touré, Catherine Seyler, Nagalingeswaran Kumarasamy, A. K. Ganesh, Robin Wood, Glenda Gray, James McIntyre, Neil A. Martinson, Lerato Mohapi, Timothy Flanigan, Kenneth Mayer

Research output: Contribution to journalArticlepeer-review

64 Scopus citations


Background: Data from HIV treatment programs in resource-limited settings show extensive rates of loss to follow-up (LTFU) ranging from 5% to 40% within 6 mo of antiretroviral therapy (ART) initiation. Our objective was to project the clinical impact and cost-effectiveness of interventions to prevent LTFU from HIV care in West Africa. Methods and Findings: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model to project the clinical benefits and cost-effectiveness of LTFU-prevention programs from a payer perspective. These programs include components such as eliminating ART co-payments, eliminating charges to patients for opportunistic infection-related drugs, improving personnel training, and providing meals and reimbursing for transportation for participants. The efficacies and costs of these interventions were extensively varied in sensitivity analyses. We used World Health Organization criteria of <3x gross domestic product per capita (3x GDP per capita = US$2,823 for Côte d'Ivoire) as a plausible threshold for "cost-effectiveness." The main results are based on a reported 18% 1-y LTFU rate. With full retention in care, projected per-person discounted life expectancy starting from age 37 y was 144.7 mo (12.1 y). Survival losses from LTFU within 1 y of ART initiation ranged from 73.9 to 80.7 mo. The intervention costing US$22/person/year (e.g., eliminating ART co-payment) would be cost-effective with an efficacy of at least 12%. An intervention costing US$77/person/year (inclusive of all the components described above) would be cost-effective with an efficacy of at least 41%. Conclusions: Interventions that prevent LTFU in resource-limited settings would substantially improve survival and would be cost-effective by international criteria with efficacy of at least 12%-41%, depending on the cost of intervention, based on a reported 18% cumulative incidence of LTFU at 1 y after ART initiation. The commitment to start ART and treat HIV in these settings should include interventions to prevent LTFU.

Original languageEnglish (US)
Article numbere1000173
JournalPLoS Medicine
Issue number10
StatePublished - Oct 2009
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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