{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:31:08Z","timestamp":1785411068427,"version":"3.56.0"},"reference-count":35,"publisher":"International Society of Global Health","license":[{"start":{"date-parts":[[2022,8,28]],"date-time":"2022-08-28T00:00:00Z","timestamp":1661644800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec id=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Timely diagnosis of HIV in infants and children is an urgent priority. In Malawi, 40,000 infants annually are HIV exposed. However, gold standard polymerase-chain-reaction (PCR) based testing requires centralised laboratories, causing turn-around times (TAT) of 2 to 3 months and significant loss to follow-up. If feasible and acceptable, minimising diagnostic delays through HIV Point-of-care-testing (POCT) may be cost-effective. We assessed whether POCT Cepheid Xpert HIV-1 Qual assay whole blood (XpertHIV) was more cost-effective than PCR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From July-August 2018, 700 PCR Abbott tests using dried blood spots (DBS) were performed on 680 participants who enrolled on the feasibility, acceptability and performance of the XpertHIV study. Newly identified HIV-positive DBS from the 680 participants were retested, so with confirmatory testing of the HIV-positive cases, 700 tests were performed. We conducted a cost-minimisation and cost-effectiveness analysis of XpertHIV against PCR, as the standard of care. A random sample of 200 caregivers from the 680 participants had semi-structured interviews to explore costs from a societal perspective of XpertHIV at Mulanje District Hospital, Malawi. Analysis used TAT as the primary outcome measure. Results were extrapolated from the study period (29 days) to a year (240 working days). Sensitivity analyses characterised individual and joint parameter uncertainty and estimated patient cost per test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the study period, XpertHIV was cost-minimising at $42.34 per test compared to $66.66 for PCR. Over a year, XpertHIV remained cost-minimising at $16.12 compared to PCR at $27.06. From the patient perspective (travel, food, lost productivity), the cost per test of XpertHIV was $2.45. XpertHIV had a mean TAT of 7.10 hours compared to 153.15 hours for PCR. Extrapolates accounting for equipment costs, lab consumables and losses to follow up estimated annual savings of $2,193,538.88 if XpertHIV is used nationally, as opposed to PCR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This preliminary evidence suggests that adopting POCT XpertHIV will save time, allowing HIV-exposed infants to receive prompt care and may improve outcomes. The Malawi government will pay less due to XpertHIV\u2019s cost savings and associated benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.52872\/001c.37787","type":"journal-article","created":{"date-parts":[[2022,8,28]],"date-time":"2022-08-28T04:39:30Z","timestamp":1661661570000},"source":"Crossref","is-referenced-by-count":0,"title":["Costing and cost-effectiveness of Cepheid Xpert HIV -1 Qual Assay using whole blood protocol versus PCR by Abbott Systems in Malawi"],"prefix":"10.7189","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9168-174X","authenticated-orcid":false,"given":"Maggie","family":"Nyirenda-Nyang'wa","sequence":"first","affiliation":[{"name":"University College London; College of Medicine, University of Malawi; Liverpool School of Tropical Medicine","department":["Infection, Immunity and Inflammation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Manthalu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03x4sv346","id-type":"ROR","asserted-by":"publisher"}],"name":"Ministry of Health","department":["Department of Planning and Policy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Arnold","sequence":"additional","affiliation":[{"name":"Institute for Applied Health Services Research (Inav); Health Economics Policy Unit (HEPU), College of Medicine, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Nkhoma","sequence":"additional","affiliation":[{"name":"Kamuzu University of Health Sciences (KUHes)","department":["Health Economics and Policy Unit (HEPU)"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina C.","family":"Hosseinipour","sequence":"additional","affiliation":[{"name":"University of North Carolina Project\u2013Malawi; University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maganizo","family":"Chagomerana","sequence":"additional","affiliation":[{"name":"University of North Carolina Project\u2013Malawi; University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Precious","family":"Chibwe","sequence":"additional","affiliation":[{"name":"Kamuzu University of Health Sciences (KUHes)","department":["Health Economics and Policy Unit (HEPU)"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Mortimer","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03svjbs84","id-type":"ROR","asserted-by":"publisher"}],"name":"Liverpool School of Tropical Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Queen University Belfast"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Fairley","sequence":"additional","affiliation":[{"name":"Queens University Belfast"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Mwapasa","sequence":"additional","affiliation":[{"name":"Kamuzu University of Health Sciences (KUHes)","department":["Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chisomo","family":"Msefula","sequence":"additional","affiliation":[{"name":"Kamuzu University of Health Sciences (KUHes)","department":["Pathology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry C.","family":"Mwandumba","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine; Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jobiba","family":"Chinkhumba","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Malawi; The Malaria Alert Centre, Kamuzu University of Health Sciences (KUHes)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Klein","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02jx3x895","id-type":"ROR","asserted-by":"publisher"}],"name":"University College London","department":["Infection, Immunity and Inflammation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dagmar","family":"Alber","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02jx3x895","id-type":"ROR","asserted-by":"publisher"}],"name":"University College London","department":["Infection, Immunity and Inflammation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Obasi","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine; The Royal Liverpool University Hospital NHS Foundation Trust","department":["International Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4223","published-online":{"date-parts":[[2022,8,28]]},"reference":[{"issue":"5","key":"ref1","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1097\/00126334-200312150-00011","article-title":"Performance characteristics of HIV-1 culture and HIV-1 DNA and RNA amplification assays for early diagnosis of perinatal HIV-1 infection","volume":"34","author":"John S. 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