{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T03:43:17Z","timestamp":1762659797927,"version":"3.37.3"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2019,5,31]],"date-time":"2019-05-31T00:00:00Z","timestamp":1559260800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","award":["IP.2009.33011.003"],"award-info":[{"award-number":["IP.2009.33011.003"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A randomized trial demonstrated that among people living with late-stage human immunodeficiency virus (HIV) infection initiating antiretroviral therapy, screening serum for cryptococcal antigen (CrAg) combined with adherence support reduced all-cause mortality by 28%, compared with standard clinic-based care. Here, we present the cost-effectiveness.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>HIV-infected adults with CD4 count &amp;lt;200 cells\/\u03bcL were randomized to either CrAg screening plus 4 weekly home visits to provide adherence support or to standard clinic-based care in Dar es Salaam and Lusaka. The primary economic outcome was health service care cost per life-year saved as the incremental cost-effectiveness ratio (ICER), based on 2017 US dollars. We used nonparametric bootstrapping to assess uncertainties and univariate deterministic sensitivity analysis to examine the impact of individual parameters on the ICER.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among the intervention and standard arms, 1001 and 998 participants, respectively, were enrolled. The annual mean cost per participant in the intervention arm was US$339 (95% confidence interval [CI], $331\u2013$347), resulting in an incremental cost of the intervention of US$77 (95% CI, $66\u2013$88). The incremental cost was similar when analysis was restricted to persons with CD4 count &amp;lt;100 cells\/\u03bcL. The ICER for the intervention vs standard care, per life-year saved, was US$70 (95% CI, $43\u2013$211) for all participants with CD4 count up to 200 cells\/\u03bcL and US$91 (95% CI, $49\u2013$443) among those with CD4 counts &amp;lt;100 cells \/\u03bcL. Cost-effectveness was most sensitive to mortality estimates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Screening for cryptococcal antigen combined with a short period of adherence support, is cost-effective in resource-limited settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciz453","type":"journal-article","created":{"date-parts":[[2019,5,30]],"date-time":"2019-05-30T19:14:16Z","timestamp":1559243656000},"page":"1652-1657","source":"Crossref","is-referenced-by-count":10,"title":["Cryptococcal Meningitis Screening and Community-based Early Adherence Support in People With Advanced Human Immunodeficiency Virus Infection Starting Antiretroviral Therapy in Tanzania and Zambia: A Cost-effectiveness Analysis"],"prefix":"10.1093","volume":"70","author":[{"given":"Godfather Dickson","family":"Kimaro","sequence":"first","affiliation":[{"name":"Muhimbili Medical Research Centre, National Institute of Medical Research, Dar es Salaam, United Republic of Tanzania"},{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorna","family":"Guinness","sequence":"first","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tinevimbo","family":"Shiri","sequence":"first","affiliation":[{"name":"Department of International Public Health, Liverpool School of Tropical Medicine, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sokoine","family":"Kivuyo","sequence":"first","affiliation":[{"name":"Muhimbili Medical Research Centre, National Institute of Medical Research, Dar es Salaam, United Republic of Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duncan","family":"Chanda","sequence":"first","affiliation":[{"name":"University Teaching Hospital, Lusaka Apex Medical University, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Bottomley","sequence":"first","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Chen","sequence":"first","affiliation":[{"name":"Department of International Public Health, Liverpool School of Tropical Medicine, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amos","family":"Kahwa","sequence":"first","affiliation":[{"name":"Muhimbili Medical Research Centre, National Institute of Medical Research, Dar es Salaam, United Republic of Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Hawkins","sequence":"first","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Mwaba","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Directorate of Research and Postgraduate Studies, Lusaka Apex Medical University, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sayoki Godfrey","family":"Mfinanga","sequence":"first","affiliation":[{"name":"Muhimbili Medical Research Centre, National Institute of Medical Research, Dar es Salaam, United Republic of Tanzania"},{"name":"Department of International Public Health, Liverpool School of Tropical Medicine, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas S","family":"Harrison","sequence":"first","affiliation":[{"name":"Institute for Infection and Immunity, Centre for Global Health, St George\u2019s University of London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shabbar","family":"Jaffar","sequence":"first","affiliation":[{"name":"Department of International Public Health, Liverpool School of Tropical Medicine, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis W","family":"Niessen","sequence":"first","affiliation":[{"name":"Department of International Public Health, Liverpool School of Tropical Medicine, United Kingdom"},{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 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