{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:01:01Z","timestamp":1783036861684,"version":"3.54.6"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T00:00:00Z","timestamp":1692057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["6 NU50CK000494-01-04"],"award-info":[{"award-number":["6 NU50CK000494-01-04"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p><jats:italic>Histoplasma<\/jats:italic> antigen can be detected in people with advanced HIV disease (AHD), allowing for early and accurate diagnosis of histoplasmosis. The aim of this analysis was to assess the cost-effectiveness of routine histoplasmosis screening using antigen detection, among people with AHD. We developed a decision analytic model to evaluate <jats:italic>Histoplasma<\/jats:italic> antigen screening among people with AHD. The model estimated the costs, effectiveness, and cost-effectiveness of routine screening for <jats:italic>Histoplasma<\/jats:italic> antigen compared to the current practice of no routine <jats:italic>Histoplasma<\/jats:italic> antigen screening. The model includes stratification by symptoms of histoplasmosis, severity of presentation, and estimates of 30-day mortality. Data sources were taken from the Pan American Health Organization (PAHO) Strategic Fund databases on public purchases of medicines, and published literature on treatment outcomes. Outcome measures are life years saved (LYS), costs (US dollars), and incremental cost-effectiveness ratios (ICERs). Routine <jats:italic>Histoplasma<\/jats:italic> antigen screening avoids an estimated 17% of deaths in persons with advanced HIV disease, and is cost-effective compared to no histoplasmosis screening, with an ICER of $26\/LYS. In sensitivity analysis assuming treatment for histoplasmosis with liposomal amphotericin, <jats:italic>Histoplasma<\/jats:italic> antigen screening remains cost-effective with an ICER of $607\/LYS. <jats:italic>Histoplasma<\/jats:italic> antigen screening among people with AHD is a cost-effective strategy and could potentially avert 17% of AIDS-related deaths. Prospective evaluation of histoplasmosis screening is warranted to determine effectiveness and treatment outcomes with this strategy.<\/jats:p>","DOI":"10.1371\/journal.pgph.0001861","type":"journal-article","created":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T17:31:11Z","timestamp":1692120671000},"page":"e0001861","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Cost-effectiveness evaluation of routine histoplasmosis screening among people living with advanced HIV disease in Latin America and the Caribbean"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5531-0231","authenticated-orcid":true,"given":"Radha","family":"Rajasingham","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narda","family":"Medina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel T.","family":"Mousquer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego H.","family":"Caceres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Jordan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Nacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego R.","family":"Falci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0966-4861","authenticated-orcid":true,"given":"Ayanna","family":"Sebro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro C.","family":"Pasqualotto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Sued","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Chiller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2001-0057","authenticated-orcid":true,"given":"Freddy","family":"Perez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,8,15]]},"reference":[{"issue":"10","key":"pgph.0001861.ref001","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/S1473-3099(18)30354-2","article-title":"Burden of HIV-associated histoplasmosis compared with tuberculosis in Latin America: a modelling study.","volume":"18","author":"AA Adenis","year":"2018","journal-title":"Lancet Infect Dis [Internet]."},{"issue":"2","key":"pgph.0001861.ref002","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/QAD.0000000000000961","article-title":"Disseminated histoplasmosis in Central and South America, the invisible elephant: The lethal blind spot of international health organizations","volume":"30","author":"M Nacher","year":"2016","journal-title":"AIDS [Internet]."},{"issue":"8","key":"pgph.0001861.ref003","doi-asserted-by":"crossref","first-page":"e3100","DOI":"10.1371\/journal.pntd.0003100","article-title":"HIV-Associated Histoplasmosis Early Mortality and Incidence Trends: From Neglect to Priority.","volume":"8","author":"A Adenis","year":"2014","journal-title":"PLoS Negl Trop Dis [Internet]."},{"issue":"1","key":"pgph.0001861.ref004","doi-asserted-by":"crossref","first-page":"42","DOI":"10.4269\/ajtmh.16-0009","article-title":"High Mortality and Coinfection in a Prospective Cohort of Human Immunodeficiency Virus\/Acquired Immune Deficiency Syndrome Patients with Histoplasmosis in Guatemala","volume":"97","author":"B Samayoa","year":"2017","journal-title":"Am J Trop Med Hyg [Internet]."},{"key":"pgph.0001861.ref005","unstructured":"UNAIDS. 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