{"doi":"10.1093/ofid/ofab603","title":"Cost-effectiveness of Routine Provider-Initiated Testing and Counseling for Children With Undiagnosed HIV in South Africa","abstract":"BACKGROUND: We compared the cost-effectiveness of pediatric provider-initiated HIV testing and counseling (PITC) vs no PITC in a range of clinical care settings in South Africa. METHODS: We used the Cost-Effectiveness of Preventing AIDS Complications Pediatric model to simulate a cohort of children, aged 2-10 years, presenting for care in 4 settings (outpatient, malnutrition, inpatient, tuberculosis clinic) with varying prevalence of undiagnosed HIV (1.0%, 15.0%, 17.5%, 50.0%, respectively). We compared \"PITC\" (routine testing offered to all patients; 97% acceptance and 71% linkage to care after HIV diagnosis) with no PITC. Model outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs) from the health care system perspective and the proportion of children with HIV (CWH) diagnosed, on antiretroviral therapy (ART), and virally suppressed. We assumed a threshold of $3200/year of life saved (YLS) to determine cost-effectiveness. Sensitivity analyses varied the age distribution of children seeking care and costs for PITC, HIV care, and ART. RESULTS: PITC improved the proportion of CWH diagnosed (45.2% to 83.2%), on ART (40.8% to 80.4%), and virally suppressed (32.6% to 63.7%) at 1 year in all settings. PITC increased life expectancy by 0.1-0.7 years for children seeking care (including those with and without HIV). In all settings, the ICER of PITC vs no PITC was very similar, ranging from $710 to $1240/YLS. PITC remained cost-effective unless undiagnosed HIV prevalence was <0.2%. CONCLUSIONS: Routine testing improves HIV clinical outcomes and is cost-effective in South Africa if the prevalence of undiagnosed HIV among children exceeds 0.2%. These findings support current recommendations for PITC in outpatient, inpatient, tuberculosis, and malnutrition clinical settings.","journal":"Open Forum Infectious Diseases","year":2021,"id":204006,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7521,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":404349,"name":"Nicole C. McCann","orcid":"0000-0002-4916-4319","position":1,"is_corresponding":false},{"id":295672,"name":"Martina Penazzato","orcid":"0000-0001-5485-8692","position":2,"is_corresponding":false},{"id":273589,"name":"Clare Flanagan","orcid":"0000-0002-2425-7690","position":3,"is_corresponding":false},{"id":611883,"name":"Shaffiq Essajee","orcid":"0000-0002-9201-9715","position":4,"is_corresponding":false},{"id":273595,"name":"Kenneth A. Freedberg","orcid":"0000-0001-6471-7930","position":5,"is_corresponding":false},{"id":517759,"name":"Meg Doherty","orcid":"0000-0003-2986-7129","position":6,"is_corresponding":false},{"id":786302,"name":"Nande Putta","orcid":null,"position":7,"is_corresponding":false},{"id":295671,"name":"Landon Myer","orcid":"0000-0002-8106-7658","position":8,"is_corresponding":false},{"id":436107,"name":"George K. Siberry","orcid":"0000-0002-5999-1596","position":9,"is_corresponding":false},{"id":361256,"name":"Intira Jeannie Collins","orcid":"0000-0003-2132-6037","position":10,"is_corresponding":false},{"id":772815,"name":"Lara Vojnov","orcid":"0000-0003-0488-1012","position":11,"is_corresponding":false},{"id":24184,"name":"Elaine J. Abrams","orcid":"0000-0001-7938-8981","position":12,"is_corresponding":false},{"id":772814,"name":"Djøra I. Soeteman","orcid":"0000-0001-8743-2604","position":13,"is_corresponding":false},{"id":273593,"name":"Andrea Ciaranello","orcid":"0000-0002-4268-3263","position":14,"is_corresponding":false},{"id":408610,"name":"Tijana Stanic","orcid":"0000-0001-6876-8735","position":0,"is_corresponding":true}],"reference_count":55,"raw_metadata":null,"created_at":"2026-07-18T23:51:22.166488Z","pmid":"35028333","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}