Improving Early Infant Diagnosis for HIV-Exposed Infants Using Micro Unmanned Aerial Vehicles Versus Motorcycles for Blood Sample in Conakry, Guinea: A Comparative Cost-Effectiveness Analysis (ARNS 12407 AIRPOP)

Background: Early infant diagnosis (EID) for HIV-exposed infants is essential because of the high mortality during the first months of their lives. In Conakry (Guinea) timely EID is difficult as traffic congestion prevents the rapid transport of blood samples to the central laboratory. We investigated the cost-effectiveness of transporting EID blood samples by micro-unmanned aerial vehicles (UAV).Methods: We conducted a cost-effectiveness comparative analysis between EID blood samples transportation by UAV compared to motorcycle using Monte Carlo simulations. Incremental cost-effectiveness ratio (ICER) per life-year gained was computed with local annual GDP per capita (US$1,194) set as the threshold. Simulation models included parameters such as consultation timing (e.g. time of arrival), motorcycle and UAV characteristics, weather and traffic conditions. Sensitivity analyses were conducted.Findings: Over a 5-year program and 318 HIV-exposed infants seen in consultation on average every year, the UAV transport strategy was able to save 24·1 life-years [90% PI: ‑15·3 –63·4]. The UAV strategy costs an additional of $37·4 [33·6 –42·0] per infant tested compared to the motorcycle one. Based on the current UAV purchase price of $23,126, the ICER of $2,497 per life-year gained was above the cost-effectiveness threshold. The ICER would fall below the threshold if the price were reduced to $8,737. The ICER is primarily sensitive to weather-related downtime, number of HIV-exposed infants and travel time saved by UAV.Interpretation: The transportation of EID blood samples by UAVs in Conakry was found above the cost-effective threshold. However, expected improvements in UAV technology and the recent availability of low-cost UAV (<$3,000) in the market suggest it could very soon be a relevant option in this setting. EID blood samples transportation by UAV could be a cost-effective strategy in other countries with traffic congestion and low rate of EID.Funding Information: The study received funding from the Agence Nationale de Recherches sur le Sida et les hépatites virales/ Maladies Infectieuses Emergentes—ANRS-MIE (grant number: ANRS 12407).Declaration of Interests: All authors declare: No support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. In addition, none of the authors have current or previous professional affiliation with the funder.Ethics Approval Statement: The study received an approval from the National Health Research Ethics Committee of Guinea on the 27 December 2019 (Ref: 119/CNERS/19).