Strategies To Reduce HIV Treatment Dropout Rates Would Be Cost-effective And Improve Survival Chances

Main Category: HIV / AIDS
Article Date: 27 Oct 2009 - 0:00 PDT

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In a study published this week in PLoS Medicine, Elena Losina (of Massachusetts General Hospital, Boston) and colleagues predict that strategies to reduce dropout rates from HIV treatment programs in resource-poor settings would substantially improve patients chances of survival and would be cost-effective. Combining a computer simulation model with data from a program of antiretroviral delivery in Abidjan, Cote d Ivoire, the researchers assessed the potential benefits of several interventions, including reducing the cost to patients of getting treatment (by eliminating co-payments for treatment and by paying for transport) and increasing the services available to patients at their visits to clinics (such as improving staff training in HIV care, and providing meals at clinic times). The researchers conclude that these strategies to reduce dropout rates from HIV treatment should form part of the commitment to start antiretroviral treatment and treat HIV in resource-poor settings.

In a related Perspective, Gregory Bisson (of the University of Pennsylvania School of Medicine) and Jeffrey Stringer (of the University of Alabama School of Medicine), both uninvolved with the research, agree that improving retention in HIV/AIDS care makes programmatic and economic sense. They stress that the major AIDS donors, such as the US Presidents Emergency Plan For AIDS Relief (PEPFAR) and the Global Fund, should be keenly interested in this issue, and willing to invest in strategies to improve retention.

Funding: Supported by the US National Institute of Allergy and Infectious Diseases (R01 AI058736, K24 AI062476, P30 AI 060354 Harvard University Center for AIDS Research, and 5U01AI069919 ART-LINC of IeDEA), the French Agence Nationale de Recherches sur le SIDA et les he patites (ANRS 12 138 ART-LINC LTFU), the Office of AIDS Research (National Institutes of Health), the National Cancer Institute, the Eunice Kennedy Shriver National Institute of Child Health & Human Development, and the Doris Duke Charitable Foundation, Clinical Scientist Development Award (to RPW). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:The authors have declared that no competing interests exist.

Citation:
"Cost-Effectiveness of Preventing Loss to Follow-up in HIV Treatment Programs: A Cote d Ivoire Appraisal."
Losina E, Toure H, Uhler LM, Anglaret X, Paltiel AD, et al. (2009)
PLoS Med 5(10): e1000173. doi:10.1371/journal.pmed.1000173

Source
PLoS Medicine