Cost-effectiveness of a peer-delivered behavioral intervention for adherence to antiretroviral therapy and alcohol and drug use in South African HIV care

Cost-effective approaches for integrating behavioral interventions for problematic alcohol and other drug (AOD) use into HIV care is needed, as problematic AOD is a primary barrier to adherence of antiretroviral therapy (ART). Thus, we investigated the cost-effectiveness of a recently completed pilot trial in South Africa, that showed promising findings in improved adherence of antiretroviral therapy (ART). The trial compared a task-shared, peer-delivered behavioral intervention (known as "Khanya") to enhanced treatment-as-usual (ETAU), a facilitated referral to a co-located AOD treatment center. A cost-effectiveness analysis was conducted from a healthcare-sector perspective and found that the mean incremental cost-effectiveness ratio was US0.4(0.7ZAR) per additional percentage point improvement in ART adherence over three - months, at which price the confidence of cost - effectiveness relative to ET AUwas108 (44 ZAR) to reach 95% confidence. The likelihood of cost-effectiveness regarding improvements in AOD score using the Global WHO-ASSIST score was low across a wide range of value thresholds.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT03529409.