In a significant development for HIV treatment in Africa, introducing drug resistance testing for patients experiencing persistent viral loads on dolutegravir-based therapies could enhance health outcomes while managing costs effectively.
Study Overview and Methodology
Researchers utilized a comprehensive individual-based model to simulate HIV progression in 100,000 adults across various African regions from 1989 to 2076. By generating 1,000 different setting scenarios, the study accounted for diverse environments in eastern, central, southern, and western Africa. The focus was on evaluating three policy options for individuals with sustained viral non-suppression on dolutegravir: switching to a protease inhibitor regimen, switching only after resistance testing, or maintaining the current regimen without testing.
Cost-Effectiveness and Health Outcomes
The analysis revealed that without switching treatments, there would be a substantial increase in disability-adjusted life-years (DALYs) despite lower costs. Conversely, implementing resistance testing before switching regimens not only reduced DALYs but also incurred lower overall costs compared to the mandatory switch approach. Specifically, the resistance test policy demonstrated an incremental cost-effectiveness ratio of $376 per DALY averted, making it a financially viable option.
- Adopting resistance testing can prevent approximately 6,900 DALYs annually.
- Switching policies without testing lead to an average of 4,400 additional DALYs each year.
- The resistance test policy reduces overall costs by $3.5 million annually compared to mandatory switching.
These findings underscore the value of integrating resistance testing into treatment protocols for HIV patients who do not achieve viral suppression with dolutegravir, offering a balanced approach between clinical outcomes and economic sustainability.
Future Implications and Recommendations
The study advocates for strategic planning to expand access to affordable, high-quality drug resistance testing across African regions. By doing so, healthcare systems can better manage HIV treatment, mitigate the rise of drug-resistant strains, and allocate resources more efficiently.
Implementing resistance testing presents a promising pathway to optimizing HIV care in Africa. Healthcare providers and policymakers should prioritize scaling up these diagnostic tools to enhance patient outcomes and sustain public health initiatives against HIV.
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