BACKGROUND The impact and cost-effectiveness of couples' voluntary HIV counselling and testing (CVCT) has not been quantified in real-world settings. We quantify cost-per-HIV-infection averted by CVCT in Zambia from the donor's perspective. METHODS From 2010 to 2016, CVCT was established in 73 Zambian government clinics. The cost-per-HIV-infection averted (CHIA) of CVCT was calculated using observed expenditures and effectiveness over longitudinal follow-up. These observed measures parameterized hypothetical 5-year nationwide implementations of: 'CVCT'; 'treatment-as-prevention (TasP) for discordant couples' identified by CVCT; and 'population TasP' for all HIV+ cohabiting persons identified by individual testing. RESULTS In all, 207 428 couples were tested (US $52/couple). Among discordant couples in which HIV+ partners self-reported antiretroviral therapy (ART), HIV incidence was 8.5/100 person-years before and 1.8/100 person-years after CVCT (79% reduction). Corresponding reductions for non-ART-using discordant and concordant negative couples were 63% and 47%, respectively. CVCT averted an estimated 58% of new infections at US $659 CHIA. In nationwide implementation models, CVCT would prevent 17 times the number of infections vs 'TasP for discordant couples' at 86% of the cost, and nine times the infections vs 'population TasP' at 28% of the cost. CONCLUSIONS CVCT is a cost-effective, feasible prevention strategy in Zambia. We demonstrate the novel, added effectiveness of providing CVCT to ART users, for whom ART use alone only partially mitigated transmission risk. Our results indicate a major policy shift (supporting development of CVCT indicators, budgets and targets) and have clinical implications (suggesting promotion of CVCT in ART clinics as a high-impact prevention strategy).

中文翻译：

---

艾滋病毒检测和咨询为非洲夫妇提供负担得起的艾滋病毒预防服务。

背景 夫妻自愿艾滋病毒咨询和检测（CVCT）的影响和成本效益尚未在现实​​环境中得到量化。我们从捐赠者的角度量化了赞比亚通过 CVCT 避免的每次 HIV 感染的成本。方法 2010年至2016年，赞比亚73家政府诊所建立了CVCT。CVCT 的每次 HIV 感染避免成本 (CHIA) 是通过纵向随访中观察到的支出和有效性来计算的。这些观察到的措施参数化了假设的 5 年全国实施情况：“CVCT”；通过 CVCT 识别“不和谐夫妻的治疗即预防 (TasP)”；以及通过个人检测确定的所有 HIV+ 同居者的“人口 TasP”。结果 总共有 207 428 对夫妇接受了测试（每对 52 美元）。在 HIV+ 伴侣自我报告抗逆转录病毒治疗 (ART) 的不一致夫妇中，CVCT 前的 HIV 发病率为 8.5/100 人年，CVCT 后为 1.8/100 人年（降低了 79%）。不使用 ART 的不一致和一致阴性配对的相应减少分别为 63% 和 47%。CVCT 以 659 美元的 CHIA 价格避免了估计 58% 的新感染。在全国范围内的实施模型中，CVCT 所预防的感染数量是“不和谐夫妇 TasP”的 17 倍，成本为 86%，而感染人数是“人口 TasP”的 9 倍，成本为 28%。结论 CVCT 在赞比亚是一种具有成本效益、可行的预防策略。我们展示了向 ART 用户提供 CVCT 的新颖且额外的有效性，对于他们来说，单独使用 ART 仅部分减轻了传播风险。我们的结果表明了重大的政策转变（支持制定 CVCT 指标、预算和目标）并具有临床意义（建议在 ART 诊所中推广 CVCT 作为一种高影响力的预防策略）。