Monitoring of HIV Viral Load, CD4 Cell Count, and Clinical Assessment
Articles Monitoring of HIV viral load, CD4 cell count, and clinical assessment versus clinical monitoring alone for antiretroviral therapy in low-resource settings (Stratall ANRS 12110/ESTHER): a cost-eff ectiveness analysis Sylvie Boyer, Laura March, Charles Kouanfack, Gabrièle Laborde-Balen, Patricia Marino, Avelin Fobang Aghokeng, Eitel Mpoudi-Ngole, Sinata Koulla-Shiro, Eric Delaporte, Maria Patrizia Carrieri, Bruno Spire, Christian Laurent, Jean-Paul Moatti, on behalf of the Stratall ANRS 12110/ESTHER Study Group* Summary Background In low-income countries, the use of laboratory monitoring of patients taking antiretroviral therapy Lancet Infect Dis 2013; (ART) remains controversial in view of persistent resource constraints. The Stratall trial did not show that clinical 13: 577–86 monitoring alone was non-inferior to laboratory and clinical monitoring in terms of immunological recovery. We Published Online aimed to evaluate the costs and cost-eff ectiveness of the ART monitoring approaches assessed in the Stratall trial. April 18, 2013 http://dx.doi.org/10.1016/ S1473-3099(13)70073-2 Methods The randomised, controlled, non-inferiority Stratall trial was done in a decentralised setting in Cameroon. See Comment page 560 Between May 23, 2006, and Jan 31, 2008, ART-naive adults were randomly assigned (1:1) to clinical monitoring *Members listed at end of paper (CLIN) or viral load and CD4 cell count plus clinical monitoring (LAB) and followed up for 24 months. We INSERM, UMR912 (SESSTIM), calculated costs, number of life-years saved (LYS), and incremental cost-eff ectiveness ratios (ICERs) with data Marseille, France (S Boyer PhD, from patients who had been followed up for at least 6 months.
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