Cost of point-of-care lateral flow urine lipoarabinomannan antigen testing in HIV-positive adults in South Africa
Karat, Aaron S.
Fielding, K. L.
Grant, A. D.
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Mukora, R., Tlali, M., Monkwe, S., Charalambous, S., Karat, A. S., Fielding, K. L., Grant, A. D. & Vassall, A. (2018) Cost of point-of-care lateral flow urine lipoarabinomannan antigen testing in HIV-positive adults in South Africa. The International Journal of Tuberculosis and Lung Disease, 22(9), pp. 1082-1087.
INTRODUCTION: The World Health Organization recommends point-of-care (POC) lateral flow urine lipoarabinomannan (LF-LAM) for tuberculosis (TB) diagnosis in selected human immunodeficiency virus (HIV) positive people. South Africa had 438 000 new TB episodes in 2016, 58.9% of which were contributed by HIV-positive people. LF-LAM is being considered for scale-up in South Africa.METHODS: We estimated the costs of using LF-LAM in HIV-positive adults with CD4 counts 6 150 cells/ll enrolled in the TB Fast Track Trial in South Africa. We also estimated costs of POC haemoglobin (Hb), as this was used in the study algorithm. Data on clinic-level (10 intervention clinics) and above-clinic-level costs were collected.RESULTS: A total of 1307 LF-LAM tests were performed at 10 clinics over 24 months. The mean cliniclevel costs were US$12.80 per patient for LF-LAM and POC Hb; LF-LAM costs were US$11.49 per patient. The mean above-clinic-level unit costs for LF-LAM were US$12.06 for clinic preparation, training, coordination and mentoring. The mean total cost of LF-LAM was US$23.55 per patient.CONCLUSION: At clinic level, the cost of LF-LAM was comparable to other TB diagnostics in South Africa. It is important to consider above-clinic-level costs for POC tests, as these may be required to support roll-out and ensure successful implementation.