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Using HIV self-testing to increase the affordability of community-based HIV testing services
Marc d'Elbée1, Molemo Charles Makhetha2, Makhahliso Jubilee3
1Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
AIDS (London, England)
|August 16, 2020
Summary
Adding HIV self-testing (HIVST) to community HIV testing services (HTS) in Lesotho improves cost-effectiveness for finding HIV-positive individuals. Reporting both full and incremental costs enhances financial planning for scaling up HIV testing programs.
Area of Science:
- Public Health
- Health Economics
- HIV/AIDS Research
Background:
- Community-based HIV testing services (HTS) are crucial for HIV prevention and care.
- Integrating novel approaches like HIV self-testing (HIVST) can potentially enhance the efficiency of HTS programs.
- Understanding the cost implications of different HTS delivery models is essential for resource allocation and program scale-up.
Purpose of the Study:
- To estimate the costs associated with community-based HTS in Lesotho.
- To assess the cost-efficiency gains from incorporating HIV self-testing (HIVST) and self-testing booths into existing HTS.
- To provide data for informed decision-making regarding HIV testing program implementation and expansion.
Main Methods:
- A micro-costing analysis was conducted using longitudinal data from a real-world intervention in Lesotho.
- Data on provider costs and programmatic outcomes were collected over three distinct implementation periods (May 2017 - April 2019).
- The study compared costs across three service delivery models: HTS only, HTS with HIVST, and HTS with HIVST including on-site self-testing booths and confirmatory testing.
Main Results:
- The cost per HIV-positive case identified varied across the implementation periods, decreasing in the final period (US$813) compared to the second (US$1249).
- Significant differences were observed between full and incremental cost analyses, highlighting the impact of methodology on cost magnitude.
- In the third period, full and incremental costs per person tested for HTS were US$34.3 and US$23.5, respectively, while for HIVST kits, they were US$37.7 and US$14.0.
Conclusions:
- Integrating HIVST into community-based HTS in Lesotho enhances overall affordability for identifying HIV-positive individuals.
- The transparent reporting of both full and incremental cost estimates is vital for effective priority setting, budgeting, and financial planning for program scale-up.
