{"doi":"10.1371/journal.pgph.0000610","title":"Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study","abstract":"Community-based delivery and monitoring of antiretroviral therapy (ART) for HIV has the potential to increase viral suppression for individual- and population-level health benefits. However, the cost-effectiveness and budget impact are needed for public health policy. We used a mathematical model of HIV transmission in KwaZulu-Natal, South Africa, to estimate population prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 2020 to 2060 for two scenarios: 1) standard clinic-based HIV care and 2) five-yearly home testing campaigns with community ART for people not reached by clinic-based care. We parameterised model scenarios using observed community-based ART efficacy. Using a health system perspective, we evaluated incremental cost-effectiveness and net health benefits using a threshold of $750/DALY averted. In a sensitivity analysis, we varied the discount rate; time horizon; costs for clinic and community ART, hospitalisation, and testing; and the proportion of the population receiving community ART. Uncertainty ranges (URs) were estimated across 25 best-fitting parameter sets. By 2060, community ART following home testing averted 27.9% (UR: 24.3-31.5) of incident HIV infections, 27.8% (26.8-28.8) of HIV-related deaths, and 18.7% (17.9-19.7) of DALYs compared to standard of care. Adolescent girls and young women aged 15-24 years experienced the greatest reduction in incident HIV (30.7%, 27.1-34.7). In the first five years (2020-2024), community ART required an additional $44.9 million (35.8-50.1) annually, representing 14.3% (11.4-16.0) of the annual HIV budget. The cost per DALY averted was $102 (85-117) for community ART compared with standard of care. Providing six-monthly refills instead of quarterly refills further increased cost-effectiveness to $78.5 per DALY averted (62.9-92.8). Cost-effectiveness was robust to sensitivity analyses. In a high-prevalence setting, scale-up of decentralised ART dispensing and monitoring can provide large population health benefits and is cost-effective in preventing death and disability due to HIV.","journal":"PLOS Global Public Health","year":2023,"id":355119,"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":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9412,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":648762,"name":"Cara J. Bayer","orcid":null,"position":1,"is_corresponding":false},{"id":315399,"name":"D. Allen Roberts","orcid":"0000-0003-3660-6330","position":2,"is_corresponding":false},{"id":392944,"name":"Heidi van Rooyen","orcid":"0000-0002-6502-6098","position":3,"is_corresponding":false},{"id":916312,"name":"Alastair van Heerden","orcid":"0000-0003-2530-6885","position":4,"is_corresponding":false},{"id":250376,"name":"Maryam Shahmanesh","orcid":"0000-0001-7129-8535","position":5,"is_corresponding":false},{"id":924684,"name":"Stephen Asiimwe","orcid":"0000-0001-6440-0036","position":6,"is_corresponding":false},{"id":1103550,"name":"Kombi Sausi","orcid":null,"position":7,"is_corresponding":false},{"id":1103091,"name":"Nsika Sithole","orcid":"0000-0003-2090-3453","position":8,"is_corresponding":false},{"id":1103092,"name":"Roger Ying","orcid":"0000-0002-0380-3197","position":9,"is_corresponding":false},{"id":647639,"name":"Darcy W. Rao","orcid":"0000-0003-0058-8513","position":10,"is_corresponding":false},{"id":546667,"name":"Meighan Krows","orcid":"0000-0003-0321-9203","position":11,"is_corresponding":false},{"id":294662,"name":"Adrienne E. Shapiro","orcid":"0000-0002-3106-1258","position":12,"is_corresponding":false},{"id":299060,"name":"Jared M. Baeten","orcid":"0000-0001-8242-8438","position":13,"is_corresponding":false},{"id":299050,"name":"Connie Celum","orcid":"0000-0002-8813-3419","position":14,"is_corresponding":false},{"id":647504,"name":"Paul Revill","orcid":"0000-0001-8632-0600","position":15,"is_corresponding":false},{"id":315406,"name":"Ruanne V. Barnabas","orcid":"0000-0002-1793-6003","position":16,"is_corresponding":false},{"id":250835,"name":"Maitreyi Sahu","orcid":"0000-0002-1593-0193","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-19T01:13:16.394812Z","pmid":"37669249","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":[]}