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COST-EFFECTIVENESS OF POINT-OF-CARE DEVICE ALLOCATION STRATEGIES: THE CASE OF EARLY INFANT DIAGNOSIS OF HIV

Mugambi, Melissa Latigo
http://rave.ohiolink.edu/etdc/view?acc_num=case1371039381

Abstract Details

2013, Doctor of Philosophy, Case Western Reserve University, Epidemiology and Biostatistics.
Point-of-care (POC) devices for HIV Early Infant Diagnosis (EID) will soon become available in resource-limited settings. During the scaling-up process, it will be important to determine the types of facilities in which implementation of the device is likely to be more cost-effective. The main objective of this dissertation was to develop a model to determine the cost-effectiveness of POC device allocation strategies in Uganda's HIV EID network. We accounted for turnaround time changes that may occur with progressive POC scale-up among facilities that perform centralized testing. In Aim 1, we evaluated the association between turnaround time and result receipt under centralized testing. Data were obtained from 703 infant HIV test records for tests performed between January 2008 and February 2009 in two health facilities in Uganda. We performed multivariable modified Poisson regression with robust standard errors and included other population and health system factors. We accounted for within-clinic correlation using generalized estimating equations. We found that caregivers were less likely to receive results at turnaround times greater than 49 days compared to 28 days in a pooled sample from both facilities (RR = 0.83; p = 0.006). In Aim 2, we developed an illustrative model comprising four health facilities that conducted centralized testing among HIV-exposed infants. We used discrete-event simulation to model centralized testing, the allocation of POC devices among the facilities, and to generate turnaround time distributions for each allocation scenario. We used individual level Markov modeling to simulate caregiver return for test results and infant HIV disease progression based on findings from Aim 1 and the turnaround time distributions. We demonstrated that our model can be used at the small-scale level to select the most cost-effective allocation strategy and scale-up approach. Our model can be extended to include a larger number of health facilities and provide evidence on the cost-effectiveness of allocation strategies at the country-level. Model projections will be important in enabling decision-makers to quantify the public health and economic impact of allocation strategies.
Mendel Singer, PhD, MPH (Committee Chair)
Sarang Deo, PhD (Committee Member)
Roger Bielefeld, PhD (Committee Member)
Kathleen Smyth, PhD (Committee Member)
150 p.
Biostatistics; Economics; Health Care; Public Health
HIV; Early Infant Diagnosis; HIV-exposed infants; Point-of-care testing; Resource allocation; Cost-effectiveness; Uganda; sub-Saharan Africa;

Recommended Citations

Citations

  • Mugambi, M. L. (2013). COST-EFFECTIVENESS OF POINT-OF-CARE DEVICE ALLOCATION STRATEGIES: THE CASE OF EARLY INFANT DIAGNOSIS OF HIV [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1371039381

    APA Style (7th edition)

  • Mugambi, Melissa. COST-EFFECTIVENESS OF POINT-OF-CARE DEVICE ALLOCATION STRATEGIES: THE CASE OF EARLY INFANT DIAGNOSIS OF HIV. 2013. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1371039381.

    MLA Style (8th edition)

  • Mugambi, Melissa. "COST-EFFECTIVENESS OF POINT-OF-CARE DEVICE ALLOCATION STRATEGIES: THE CASE OF EARLY INFANT DIAGNOSIS OF HIV." Doctoral dissertation, Case Western Reserve University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1371039381

    Chicago Manual of Style (17th edition)

case1371039381
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© 2013, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.