Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 154 No. 4 (2024)

Costs and acceptability of simplified monitoring in HIV-suppressed patients switching to dual therapy: the SIMPL’HIV open-label, factorial randomised controlled trial

  • Annalisa Marinosci
  • Delphine Sculier
  • Gilles Wandeler
  • Sabine Yerly
  • Marcel Stoeckle
  • Enos Bernasconi
  • Dominique L. Braun
  • Pietro Vernazza
  • Matthias Cavassini
  • Marta Buzzi
  • Karin J. Metzner
  • Laurent Decosterd
  • Huldrych F. Günthard
  • Patrick Schmid
  • Andreas Limacher
  • Mattia Branca
  • Alexandra Calmy
Cite this as:
Swiss Med Wkly. 2024;154:3762


BACKGROUND: Clinical and laboratory monitoring of patients on antiretroviral therapy is an integral part of HIV care and determines whether treatment needs enhanced adherence or modification of the drug regimen. However, different monitoring and treatment strategies carry different costs and health consequences.

MATERIALS AND METHODS: The SIMPL’HIV study was a randomised trial that assessed the non-inferiority of dual maintenance therapy. The co-primary outcome was a comparison of costs over 48 weeks of dual therapy with standard antiretroviral therapy and the costs associated with a simplified HIV care approach (patient-centred monitoring [PCM]) versus standard, tri-monthly routine monitoring. Costs included outpatient medical consultations (HIV/non-HIV consultations), non-medical consultations, antiretroviral therapy, laboratory tests and hospitalisation costs. PCM participants had restricted immunological and blood safety monitoring at weeks 0 and 48, and they were offered the choice to complete their remaining study visits via a telephone call, have medications delivered to a specified address, and to have blood tests performed at a location of their choice. We analysed the costs of both strategies using invoices for medical consultations issued by the hospital where the patient was followed, as well as those obtained from health insurance companies. Secondary outcomes included differences between monitoring arms for renal function, lipids and glucose values, and weight over 48 weeks. Patient satisfaction with treatment and monitoring was also assessed using visual analogue scales.

RESULTS: Of 93 participants randomised to dolutegravir plus emtricitabine and 94 individuals to combination antiretroviral therapy (median nadir CD4 count, 246 cells/mm3; median age, 48 years; female, 17%),patient-centred monitoring generated no substantial reductions or increases in total costs (US$ –421 per year [95% CI –2292 to 1451]; p = 0.658). However, dual therapy was significantly less expensive (US$ –2620.4 [95% CI –2864.3 to –2331.4]) compared to standard triple-drug antiretroviral therapy costs. Approximately 50% of participants selected one monitoring option, one-third chose two, and a few opted for three. The preferred option was telephone calls, followed by drug delivery. The number of additional visits outside the study schedule did not differ by type of monitoring. Patient satisfaction related to treatment and monitoring was high at baseline, with no significant increase at week 48.

CONCLUSIONS: Patient-centred monitoring did not reduce costs compared to standard monitoring in individuals switching to dual therapy or those continuing combined antiretroviral therapy. In this representative sample of patients with suppressed HIV, antiretroviral therapy was the primary factor driving costs, which may be reduced by using generic drugs to mitigate the high cost of lifelong HIV treatment.

Trial registration: NCT03160105.


  1. WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: World Health Organization; 2016. Available from:
  2. The state of the HIV market in low- and middle-income countries. Clinton Health Access Initiative. 2020. Available from:
  3. Grimsrud A, Bygrave H, Doherty M, Ehrenkranz P, Ellman T, Ferris R, et al. Reimagining HIV service delivery: the role of differentiated care from prevention to suppression. J Int AIDS Soc. 2016 Dec;19(1):21484. 10.7448/IAS.19.1.21484 DOI:
  4. Roy M, Bolton Moore C, Sikazwe I, Holmes CB. A review of differentiated service delivery for HIV treatment: effectiveness, mechanisms, targeting, and scale. Curr HIV/AIDS Rep. 2019 Aug;16(4):324–34. 10.1007/s11904-019-00454-5 DOI:
  5. Sculier D, Wandeler G, Yerly S, Marinosci A, Stoeckle M, Bernasconi E, et al.; Swiss HIV Cohort Study (SHCS). Efficacy and safety of dolutegravir plus emtricitabine versus standard ART for the maintenance of HIV-1 suppression: 48-week results of the factorial, randomized, non-inferiority SIMPL’HIV trial. PLoS Med. 2020 Nov;17(11):e1003421. 10.1371/journal.pmed.1003421 DOI:
  6. Swiss HIV Cohort Study, Schoeni-Affolter F, Ledergerber B, Rickenbach M, Rudin C, Günthard HF, et al. Cohort profile: the Swiss HIV Cohort study. Int J Epidemiol. 2010;39:1179–89. DOI:
  7. Verolet CM, Delhumeau-Cartier C, Sartori M, Toma S, Zawadynski S, Becker M, et al.; LIPO Group Metabolism. Lipodystrophy among HIV-infected patients: a cross-sectional study on impact on quality of life and mental health disorders. AIDS Res Ther. 2015 Jun;12(1):21. 10.1186/s12981-015-0061-z DOI:
  8. R: The R Project for Statistical Computing. Available from:
  9. Sloan CE, Champenois K, Choisy P, Losina E, Walensky RP, Schackman BR, et al.; Cost-Effectiveness of Preventing AIDS Complications (CEPAC) investigators. Newer drugs and earlier treatment: impact on lifetime cost of care for HIV-infected adults. AIDS. 2012 Jan;26(1):45–56. 10.1097/QAD.0b013e32834dce6e DOI:
  10. Nakagawa F, Miners A, Smith CJ, Simmons R, Lodwick RK, Cambiano V, et al. Projected lifetime healthcare costs associated with HIV infection. PLoS One. 2015 Apr;10(4):e0125018. 10.1371/journal.pone.0125018 DOI:
  11. Treskova M, Kuhlmann A, Bogner J, Hower M, Heiken H, Stellbrink HJ, et al. Analysis of contemporary HIV/AIDS health care costs in Germany: driving factors and distribution across antiretroviral therapy lines. Medicine (Baltimore). 2016 Jun;95(26):e3961. 10.1097/MD.0000000000003961 DOI:
  12. Tucker A, Tembo T, Tampi RP, Mutale J, Mukumba-Mwenechanya M, Sharma A, et al. Redefining and revisiting cost estimates of routine ART care in Zambia: an analysis of ten clinics. J Int AIDS Soc. 2020 Feb;23(2):e25431. 10.1002/jia2.25431 DOI:
  13. Krentz HB, Vu Q, Gill MJ. Updated direct costs of medical care for HIV-infected patients within a regional population from 2006 to 2017. HIV Med. 2020 May;21(5):289–98. 10.1111/hiv.12824 DOI:
  14. Leon-Reyes S, Schäfer J, Früh M, Schwenkglenks M, Reich O, Schmidlin K, et al. Cost estimates for human immunodeficiency virus (HIV) care and patient characteristics for health resource use from linkage of claims data with the Swiss HIV Cohort Study. Clin Infect Dis. 2019 Feb;68(5):827–33. 10.1093/cid/ciy564 DOI:
  15. Tran H, Saleem K, Lim M, Chow EP, Fairley CK, Terris-Prestholt F, et al. Global estimates for the lifetime cost of managing HIV: a systematic review. AIDS. 2021 Mar;35(8):1273–81. 10.1097/QAD.0000000000002887 DOI:
  16. Larson BA, Pascoe SJ, Huber A, Long LC, Murphy J, Miot J, et al. Will differentiated care for stable HIV patients reduce healthcare systems costs? J Int AIDS Soc. 2020 Jul;23(7):e25541. 10.1002/jia2.25541 DOI:
  17. Shrestha RK, Schommer JC, Taitel MS, Garza OW, Camp NM, Akinbosoye OE, et al.; Patient-centered HIV Care Model Team. Costs and cost-effectiveness of the patient-centered HIV care model: a collaboration between community-based pharmacists and primary medical providers. J Acquir Immune Defic Syndr. 2020 Nov;85(3):e48–54. 10.1097/QAI.0000000000002458 DOI:
  18. Cooper V, Clatworthy J, Youssef E, Llewellyn C, Miners A, Lagarde M, et al. Which aspects of health care are most valued by people living with HIV in high-income countries? A systematic review. BMC Health Serv Res. 2016 Nov;16(1):677. 10.1186/s12913-016-1914-4 DOI:
  19. Préau M, Protopopescu C, Raffi F, Rey D, Chêne G, Marcellin F, et al.; Anrs Co8 Aproco-Copilote Study Group. Satisfaction with care in HIV-infected patients treated with long-term follow-up antiretroviral therapy: the role of social vulnerability. AIDS Care. 2012;24(4):434–43. 10.1080/09540121.2011.613909 DOI:
  20. Dang BN, Westbrook RA, Black WC, Rodriguez-Barradas MC, Giordano TP. Examining the link between patient satisfaction and adherence to HIV care: a structural equation model. PLoS One. 2013;8(1):e54729. 10.1371/journal.pone.0054729 DOI:
  21. Pérez-Salgado D, Compean-Dardón MS, Staines-Orozco MG, Ortiz-Hernández L. Satisfaction with healthcare services and adherence to antiretroviral therapy among patients with HIV attending two public nstitutions. Rev Invest Clin. 2015;67(2):80–8.
  22. Flickinger TE, Saha S, Moore RD, Beach MC. Higher quality communication and relationships are associated with improved patient engagement in HIV care. J Acquir Immune Defic Syndr. 2013 Jul;63(3):362–6. 10.1097/QAI.0b013e318295b86a DOI:

Most read articles by the same author(s)

1 2 3 4 > >>