Increasing the use of second-line therapy is a cost-effective approach to prevent the spread of drug-resistant HIV: a mathematical modelling study

METHODS: We develop a deterministic mathematical model representing Kampala, Uganda, to predict the prevalence of TDR over a 10-year period. We then compare the impact on TDR and cost-effectiveness of: (1) introduction of pre-therapy genotyping; (2) doubling use of second-line treatment to 80% (50-90%) of patients with confirmed virological failure on first-line ART; and (3) increasing viral load monitoring from yearly to twice yearly. An intervention can be considered cost-effective if it costs less than three times the gross domestic product per capita per quality adjusted life year (QALY) gained, or less than $3420 in Uganda.RESULTS: The prevalence of TDR is predicted to rise from 6.7$1612 to $2234 (IQR$450-dominated) per QALY gained.CONCLUSIONS: While earlier treatment initiation will result in a predicted increase in the proportion of patients infected with drug-resistant HIV, the absolute numbers of patients infected with drug-resistant HIV is predicted to decrease. Increasing use of second-line treatment to all patients with confirmed failure on first-line therapy is a cost-effective approach to reduce TDR. Improving access to second-line ART is therefore a major priority.INTRODUCTION: Earlier antiretroviral therapy (ART) initiation reduces HIV-1 incidence. This benefit may be offset by increased transmitted drug resistance (TDR), which could limit future HIV treatment options. We analyze the epidemiological impact and cost-effectiveness of strategies to reduce TDR

Stop Flow Lithography Synthesis and Characterization of Structured Microparticles

In this study, the synthesis of nonspherical composite particles of poly(ethylene glycol) diacrylate (PEG-DA)/SiO2 and PEG-DA/Al2O3 with single or multiple vias and the corresponding inorganic particles of SiO2 and Al2O3 synthesized using the Stop Flow Lithography (SFL) method is reported. Precursor suspensions of PEG-DA, 2-hydroxy-2-methylpropiophenone, and SiO2 or Al2O3 nanoparticles were prepared. The precursor suspension flows through a microfluidic device mounted on an upright microscope and is polymerized in an automated process. A patterned photomask with transparent geometric features masks UV light to synthesize the particles. Composite particles with vias were synthesized and corresponding inorganic SiO2 and Al2O3 particles were obtained through polymer burn-off and sintering of the composites. The synthesis of porous inorganic particles of SiO2 and Al2O3 with vias and overall dimensions in the range of ~35–90 µm was achieved. BET specific surface area measurements for single via inorganic particles were 56–69 m2/g for SiO2 particles and 73–81 m2/g for Al2O3 particles. Surface areas as high as 114 m2/g were measured for multivia cubic SiO2 particles. The findings suggest that, with optimization, the particles should have applications in areas where high surface area is important such as catalysis and sieving