Comparative cost analysis of point-of-care versus laboratory-based testing to initiate and monitor HIV treatment in South Africa

Autoři: Kate Simeon aff001;  Monisha Sharma aff002;  Jienchi Dorward aff003;  Jessica Naidoo aff003;  Ntuthu Dlamini aff004;  Pravikrishnen Moodley aff005;  Natasha Samsunder aff003;  Ruanne V. Barnabas aff001;  Nigel Garrett aff003;  Paul K. Drain aff001
Působiště autorů: Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America aff001;  Department of Global Health, Schools of Public Health and Medicine, University of Washington, Seattle, Washington, United States of America aff002;  Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu–Natal, Durban, South Africa aff003;  Prince Cyril Zulu Communicable Disease Clinic, Ethekwini Municipality, Durban, South Africa aff004;  Department of Virology, National Health Laboratory Service and University of KwaZulu-Natal, Durban, South Africa aff005;  Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America aff006;  Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



The number of people living with HIV (PLHIV) in need of treatment monitoring in low-and-middle-income countries has been rapidly expanding, placing an increasing burden on laboratories. Promising new point-of-care (POC) test have the potential to reduce laboratory workloads, but the implementation cost is uncertain. We sought to estimate the costs of decentralized POC testing compared to centralized laboratory testing for PLHIV initiating treatment in South Africa.


We conducted a microcosting analyses comparing clinic-based POC testing to centralized laboratory testing for HIV viral load, creatinine, and CD4 count monitoring. We completed time-and-motion studies to assess staff time for sample collection and processing. Instrument costs were estimated assuming five-year lifespans and we applied a 3% annual discount rate. Total costs and cost per patient were estimated over a five-year period: the first year of ART initiation and four years of routine HIV monitoring, following World Health Organization ART monitoring guidelines.


We estimated that per-patient costs of POC HIV viral load, CD4, and creatinine tests were USD $25, $11, and $9, respectively, assuming a clinic volume of 50 patients initiated per month. At centralized laboratories, per-patient costs of POC HIV viral load, CD4, and creatinine tests were USD $26, $6, $3. Total monitoring costs of all testing over a 5-year period was $45 higher for POC testing compared to centralized laboratory testing ($210 vs $166).


POC testing for HIV care and treatment can be feasibly implemented within clinics in South Africa, particularly those with larger patient volumes. POC HIV viral load costs are similar to lab-based testing while CD4 count and creatinine testing are more costly as POC tests. Our cost estimates are useful to policymakers in planning resource allocation and can inform cost-effectiveness analyses of POC testing.

Klíčová slova:

Clinical laboratories – Creatinine – Government laboratories – South Africa – Viral load – Laboratory tests


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2019 Číslo 10
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