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In resource-limited settings, providers often make decisions about starting and switching antiretroviral regimens without the benefit of CD4-cell–count or viral-load information. Some experts argue that such imperfect decision making limits the effectiveness of individual patients’ regimens and that laboratory monitoring should be implemented on a population level. Others argue, however, that laboratory monitoring would be too expensive and that resources are better spent placing additional patients on antiretroviral therapy (ART). A new cost-effectiveness analysis adds insight to the debate.
Using a mathematical model of HIV disease in South Africa, investigators examined the outcomes and costs associated with 10 different strategies for de…