Dropout and re-enrollment

• DOI: 10.1097/qad.0000000000000081
• Publication Date: 2014-01-27T23:49:41Z
• Authors: Daniel J. Klein; Anna Bershteyn; Philip A. Eckhoff
• Keywords: Dropout (neural networks)

Objective: EMOD-HIV v0.8 has been used to estimate the potential impact of expanding treatment guidelines allow earlier initiation antiretroviral therapy (ART) in sub-Saharan Africa with current or improved coverage. In generating these results, a model must additionally make assumptions about rates dropout and re-initiation into ART programs before after program change, which little is known. The objective this work rigorously analyze modeling sensitivity results respect relevant mechanisms parameters. Methods: We varied key pertaining re-enrollment their effect on cost, impact, cost-effectiveness guidelines, coverage via testing linkage care. Additionally, we performed analysis 17 Setting: South Africa. Results: Allowing irrespective prior doubled cost as compared scenario could only be triggered by health event (AIDS symptoms, diagnosis partner, an antenatal care visit). Increasing probability ‘voluntary’ (not event) was most cost-effective way improve program, especially short term because it provided immediate benefits those who would otherwise have delayed until onset AIDS symptoms. However, maximum change limited through improvements Beyond re-initiation, further gains made improving retention Only optimal expansion cost-saving 20 years due reductions transmission. Re-initiation did not reduce transmission sufficiently guideline that occurred while patients were away from Sensitivity suggested enormous attained regimens higher efficacy at preventing transmission, increasing proportion population access healthcare, reducing ‘leaks’ ‘cascade care.’ individuals receive CD4+ cell particularly baseline levels coverage, expanded Conclusion: This provides sense magnitude uncertainty policy-makers anticipate face uncertain future programmatic changes. Our findings suggest means initial improvement, term, but are necessary order reap full transmission-blocking test-and-treat long term.