Cost-effectiveness of implementing assisted partner notification for HIV in Kenya: A mathematical modeling analysis

Background: Assisted partner services (aPS) or provider notification for sexual partners of persons diagnosed HIV-positive can increase HIV testing and linkage to care in sub-Saharan Africa. Additionally, aPS is a high yield strategy to identify persons with HIV. However, aPS is resource intensive and its cost-effectiveness is not well-evaluated. Methods: Using primary cost and effectiveness data from a randomized clinical trial of aPS in Kenya, we parameterized an individual-based, stochastic, dynamic mathematical model of HIV transmission. The model incorporates partner concurrency, migration, coinfection with sexually transmitted infections, household structure, and health seeking behavior. We simulated 200 cohorts of 500,000 individuals and calculated the incremental cost-effectiveness of scaling up aPS in a region of western Kenya (formerly Nyanza Province) under different thresholds of ART initiation (CD4≤ 350, CD4≤ 500, and all HIV+ persons), with CD4≤ 500 as the base-case.Findings: Over a 10 year time horizon, adding aPS to standard of care in western Kenya is projected achieve 12% population coverage and reduce HIV infections by 2.8% and HIV-related deaths by 1.5%. The incremental cost-effectiveness ratio (ICER) of implementing aPS is $1,703 USD (range $1,198-2,887) per disability-adjusted life year (DALY) averted. Task-shifting intervention activities from healthcare professionals to community health workers decreases the ICER to $1,302 (range $955-2,789) per DALY averted. The task-shifting scenario falls below Kenya’s per capita gross domestic product (GDP) and is therefore considered very cost-effective while …