Projecting the epidemiological effect, cost-effectiveness and transmission of HIV drug resistance in Vietnam associated with viral load monitoring strategies

Quang Duy Pham, David P. Wilson, Thuong Vu Nguyen, Nhan Thi Do, Lien Xuan Truong, Long Thanh Nguyen, Lei Zhang

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9 Citations (Scopus)


Objectives: The objective of this study was to investigate the potential epidemiological impact of viral load (VL)monitoring and its cost-effectiveness in Vietnam, where transmitted HIV drug resistance (TDR) prevalence hasincreased from <5% to 5%-15% in the past decade.

Methods: Using a population-based mathematical model driven by data from Vietnam, we simulated scenariosof various combinations of VL testing coverage, VL thresholds for second-line ART initiation and availability of HIVdrug-resistance tests. We assessed the cost per disability-adjusted life year (DALY) averted for each scenario.

Results: Projecting expected ART scale-up levels, to approximately double the number of people on ART by 2030,will lead to an estimated 18510 cases (95% CI: 9120-34600 cases) of TDR and 55180 cases (95% CI: 40540-65900 cases) of acquired drug resistance (ADR) in the absence of VL monitoring. This projection corresponds to aTDR prevalence of 16% (95% CI: 11%-24%) and ADR of 18% (95% CI: 15%-20%). Annual or biennial VL monitoringwith 30% coverage is expected to relieve 12%-31% of TDR (2260-5860 cases), 25%-59% of ADR (9620-22650 cases), 2%-6% of HIV-related deaths (360-880 cases) and 19270-51400 DALYs during 2015-30. The30% coverage of VL monitoring is estimated to cost US$4848-5154 per DALY averted. The projected additionalcost for implementing this strategy is US$105-268 million over 2015-30.

Conclusions: Our study suggests that a programmatically achievable 30% coverage of VL monitoring can haveconsiderable benefits for individuals and leads to population health benefits by reducing the overall national burdenof HIV drug resistance. It is marginally cost-effective according to common willingness-to-pay thresholds.

Original languageEnglish
Article numberdkv473
Pages (from-to)1367-1379
Number of pages13
JournalJournal of Antimicrobial Chemotherapy
Issue number5
Publication statusPublished - 1 May 2016

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