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Understanding the cost-utility of implementing HIV self-testing with digital-based supports.

Brianna Empringham1,2, Angela Karellis3, Marta Fernandez-Suarez4

  • 1School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

Frontiers in Public Health
|January 29, 2025
PubMed
Summary

Digital HIV self-testing (HIVST) is cost-effective compared to facility-based testing, increasing accessibility and linkage to care. Strategies to improve cost-utility include reducing testing costs and targeting key populations.

Keywords:
HIVMarkov modeldigital-based interventionhealth economicsself-testing

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Area of Science:

  • Public Health
  • Health Economics
  • Infectious Disease Epidemiology

Background:

  • HIV self-testing (HIVST) increases HIV testing uptake compared to facility-based testing.
  • Digital supports may enhance HIVST accessibility and linkage to care.
  • Economic evidence for digital HIVST is limited.

Purpose of the Study:

  • Evaluate the cost-utility of digital-based HIVST compared to community-based HIVST and facility-based testing.
  • Analyze cost-effectiveness across Malawi, South Africa, and Brazil.

Main Methods:

  • Utilized published cost and efficacy data for HIVST interventions.
  • Developed a combined Markov and decision analytic model.
  • Included digital interventions (text messaging, websites) and community-based interventions (door-to-door, peer-incentivized, mobile units).

Main Results:

  • HIVST proved cost-effective versus facility-based testing in all settings.
  • Digital-based HIVST showed incremental costs of $769–$17,839/DALY averted compared to facility-based testing.
  • Digital-based HIVST had an incremental cost of $7,300/DALY averted compared to community-based HIVST, with key drivers including testing costs, positivity rates, and linkage to care.

Conclusions:

  • Digital HIVST with digital supports is a potentially highly cost-effective strategy.
  • Digital supports improve accessibility and linkage to care, key drivers of cost-utility.
  • Improving cost-utility involves reducing testing costs, targeting high-positivity populations, and strengthening linkage to care.