Reaching Absent and Refusing Individuals During Home-Based HIV Testing Through Self-Testing-at What Cost?

Area of Science:

• Public Health
• Health Economics
• HIV/AIDS Prevention

Background:

• Home-based HIV testing campaigns in rural Lesotho aim to increase testing coverage.
• Secondary distribution of oral self-tests was implemented to reach individuals absent or refusing initial testing.
• The HOSENG trial (NCT03598686) evaluated the impact of this secondary distribution strategy.

Purpose of the Study:

• To determine the per-patient costs associated with home-based HIV testing.
• To compare the costs of HIV testing with and without secondary self-test distribution.
• To evaluate the cost-effectiveness of secondary self-test distribution in improving HIV testing coverage.

Main Methods:

• A micro-costing study using a mixed top-down and bottom-up approach was conducted.
• Provider costs were estimated from a provider's perspective for both intervention and control arms.
• Financial and economic costs per patient were calculated for different testing cascade scenarios, adjusted to 2018 US dollars.

Main Results:

• The cost per person eligible for testing was higher in the intervention arm (US$11.79) versus the control arm (US$10.50), primarily due to self-test costs.
• However, the cost per person tested was significantly lower in the intervention arm (US$15.70) compared to the control arm (US$22.15) due to increased testing coverage.
• The cost per person newly diagnosed with HIV was US$889.79 in the intervention arm and US$753.17 in the control arm.

Conclusions:

• Secondary distribution of oral self-tests is a cost-effective strategy for increasing HIV testing coverage in home-based campaigns.
• This approach reduces the cost per person tested, making it a valuable add-on for HIV testing initiatives in similar settings.
• The study highlights the potential of self-testing distribution to overcome barriers to HIV testing in rural populations.