Health outcomes and cost-effectiveness of treating depression in people with HIV in Sub-Saharan Africa: a model-based analysis

ABSTRACT

High prevalence of depression among people living with HIV (PLHIV) impedes antiretroviral therapy (ART) adherence and viral suppression. We estimate the effectiveness and cost-effectiveness of strategies to treat depression among PLHIV in Sub-Saharan Africa (SSA). We developed a microsimulation model of HIV disease and care in Uganda which captured individuals’ depression status and the relationship between depression and HIV behaviors. We consider a strategy of screening for depression and providing antidepressant therapy with fluoxetine at ART initiation or re-initiation (if a patient has dropped out). We estimate that over 10 years this strategy would reduce prevalence of depression among PLHIV by 16.0% [95% uncertainty bounds 15.8%, 16.1%] from a baseline prevalence of 28%, increase adherence to ART by 1.0% [1.0%, 1.0%], and decrease rates of loss to followup by 3.7% [3.4%, 4.1%]. This would decrease first-line ART failure rates by 2.5% [2.3%, 2.8%] and increase viral suppression rates by 1.0% [1.0%, 1.0%]. This strategy costs $15/QALY compared to the status quo, and was highly cost-effective over a broad range of sensitivity analyses. We conclude that screening for and treating depression among PLHIV in SSA with fluoxetine would be effective in improving HIV treatment outcomes and would be highly cost-effective.

KEYWORDS:

• HIV
• mental health
• depression
• cost-effectiveness

Acknowledgments

Author Contributions: Huaiyang Zhong is responsible for all of the modeling and data analysis in this study. Study concept and design: Zhong, Arjmand, Brandeau and Bendavid. Acquisition of data: Zhong and Bendavid. Analysis and interpretation of data: Zhong, Brandeau and Bendavid. Drafting of the manuscript: Zhong, Brandeau and Bendavid. Critical revision of the manuscript for important intellectual content: Zhong, Brandeau and Bendavid. Statistical analysis: Zhong and Bendavid. Study supervision: Brandeau and Bendavid.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Previous Presentations

2016 Institute for Operations Research and the Management Sciences (INFORMS) Annual Meeting in Nashville, Tennessee

Additional information

Funding

Financial support for this study was provided by Grant Number 1-R01-DA15612 from the National Institute on Drug Abuse and Grant Number R01-AI127250 from the National Institute of Allergy and Infectious Diseases.