Optimized placement of POC HIV testing devices boosts infant ART initiation in Zimbabwe
The study reports a microsimulation and location-optimization analysis for deploying point-of-care HIV testing devices across 122 clinics in Zimbabwe. Investigators found that shifting 11 of 17 existing devices to new sites increased the 30-day result return rate from 43.8% to 52.6% and raised 30-day ART initiation among infected infants from 41.6% to 50.0%, while maintaining a cost of approximately $211 per infant. Ensuring at least one device per district further improved result return to 53.3% and ART initiation to 50.6%. These findings demonstrate that data-driven geographic optimization of POC testing infrastructure can meaningfully accelerate infant HIV diagnosis and treatment initiation in resource-limited settings.
The original study
Optimizing the location of point-of-care infant HIV testing devices in Zimbabwe to maximize impact and value: A modeling analysis.
- Authors
- Vivas-Valencia C, Webb KA, Flanagan CF, Takarinda K, Coskun E, Chimwaza A, et al.
- Journal
- PloS one
- Type
- Journal Article
- PMID
- 42664273
Original abstract
BACKGROUND: Early HIV diagnosis in infants is essential for timely antiretroviral therapy (ART) initiation, but requires virologic testing - often performed in centralized laboratories, which can delay results and treatment initiation. Point-of-care (POC) testing delivers same-day results, facilitating prompt diagnosis and treatment, but availability is limited in low-resource settings. We aimed to optimally locate POC machines to improve life expectancy (LE) and net health benefit (NHB) for infants born to people with HIV in Zimbabwe. METHODS: We linked the validated CEPAC-Pediatric HIV microsimulation model, populated with detailed subnational programmatic data, with a location-optimization model for 122 clinics in Matabeleland South's 7 districts. Simulating two testing strategies - conventional laboratory-based and POC machine-based - we projected: 30-day result-return, 30-day ART initiation for children with HIV (CWH), LE, HIV-related healthcare costs, and NHB. We maximized LE or NHB for infants tested at 6-10 weeks old. FINDINGS: With 17 POC devices in current locations, a projected 43.8% of tested infants would receive HIV test results, with 41.6% of CWH starting ART within 30 days. Undiscounted LE would be 67.85 years (25.91 among CWH), with average discounted lifetime costs of $202/infant. Optimizing locations to maximize LE would retain 6 devices in current locations and move 11 to new sites, leading to projected 52.6% 30-day result-return, 50.0% 30-day ART initiation, and 67.88 years LE (27.04 among CWH), costing $211/infant. Maximizing NHB with a willingness-to-pay threshold ≥ $1,164 (66% of Zimbabwe's GDP per capita) would render the same optimal locations as maximizing LE. Additional optimally-located machines would further improve LE. Ensuring one machine per district while maximizing LE would require one additional machine and would increase 30-day result-return (to 53.3%), ART initiation (to 50.6%), and LE (to 67.88 years, 27.11 for CWH), costing $212/infant. INTERPRETATION: Data-driven optimization of POC machine location could improve HIV detection and increase life expectancy and net health benefit for infants undergoing HIV testing in Zimbabwe.