{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,3,30]],"date-time":"2024-03-30T14:26:31Z","timestamp":1711808791941},"reference-count":33,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,8,26]],"date-time":"2020-08-26T00:00:00Z","timestamp":1598400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Scaling up of point\u2010of\u2010care testing (POCT) for early infant diagnosis of HIV (EID) could reduce the large gap in infant testing. However, suboptimal POCT EID could have limited impact and potentially high avoidable costs. This study models the cost\u2010effectiveness of a quality assurance system to address testing performance and screening interruptions, due to, for example, supply stockouts, in Kenya, Senegal, South Africa, Uganda and Zimbabwe, with varying HIV epidemics and different health systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We modelled a quality assurance system\u2010raised EID quality from suboptimal levels: that is, from misdiagnosis rates of 5%, 10% and 20% and EID testing interruptions in months, to uninterrupted optimal performance (98.5% sensitivity, 99.9% specificity). For each country, we estimated the 1\u2010year impact and cost\u2010effectiveness (US$\/DALY averted) of improved scenarios in averting missed HIV infections and unneeded HIV treatment costs for false\u2010positive diagnoses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The modelled 1\u2010year costs of a national POCT quality assurance system range from US$ 69\u00a0359 in South Africa to US$ 334\u00a0341 in Zimbabwe. At the country level, quality assurance systems could potentially avert between 36 and 711 missed infections (i.e. false negatives) per year and unneeded treatment costs between US$ 5808 and US$ 739\u00a0030.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The model estimates adding effective quality assurance systems are cost\u2010saving in four of the five countries within the first year. Starting EQA requires an initial investment but will provide a positive return on investment within five years by averting the costs of misdiagnoses and would be even more efficient if implemented across multiple applications of POCT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13472","type":"journal-article","created":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T08:59:38Z","timestamp":1596272378000},"page":"1235-1245","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The potential for quality assurance systems to save costs and lives: the case of early infant diagnosis of HIV"],"prefix":"10.1111","volume":"25","author":[{"given":"F.","family":"Terris\u2010Prestholt","sequence":"first","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Boeras","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"},{"name":"Global Health Impact Group Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. 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