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

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.