Acceptability and cost-effectiveness of blood sample transport by drone for HIV-testing of infants exposed to HIV in the city of Conakry, Guinea (ANRS 12407 AIRPOP)


BACKGROUND: Early infant diagnosis (EID) of HIV is essential because of the high mortality of HIV-infected infants during the first months of their lives. In Conakry timely EID is difficult as traffic congestion prevents the rapid transport of blood samples to the central laboratory. We investigated the cost-effectiveness and acceptability of transporting EID blood samples by drone.
METHODS: The incremental cost-effectiveness ratio (ICER) per life-year gained of drone transport compared to motorcycle transport was estimated using Monte Carlo simulations. The local annual GDP per capita (1,160 USD) was set as the threshold. The main parameters and data sources used are presented (Figure 1). Interviews were conducted with 65 stakeholders including postpartum women, local residents and policy makers. The drones were demonstrated to these individuals.

RESULTS: Based on the current purchase price for a drone of 22,500 USD, the ICER of 2,504 USD/ life-year gained is above the cost-effectiveness threshold. The ICER would fall below the threshold if the price reduced to 8000 USD.The ICER is sensitive to weather-related downtime, number of exposed infants, and drone speed
(Figure 2).
Post-partum women perceived that the use of drones could reduce the time taken to receive EID results. Health policy makers expressed the view that drone use could improve care decentralization and allow for the transportation of other health products.

CONCLUSIONS: The transportation of EID blood samples by drone whilst highly acceptable is not currently cost-effective in Conakry. Expected improvements in drone technology and decreases in purchase costs suggest it may soon be an acceptable option.

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