Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia

Abstract

Background The study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence. Methods A cost model was developed to highlight the trade-offs between test and economic efficiency from a provider perspective. First, an estimate of the number of tests needed to find a true (previously undiagnosed) positive diagnosis was made. Second, estimates of the average cost per positive diagnosis in whole of population (WoP) and men who have sex with men (MSM) was made, then third, aggregated to the total cost for diagnosis of all undetected infections. Results Parallel testing is as effective as conventional testing, but more economically efficient. POC testing provide two significant advantages over conventional testing: they screen out negatives effectively at comparatively lower cost and, with confirmatory testing of reactive results, there is no loss in efficiency. The average and total costs per detection in WoP are prohibitive, except for Home Self Testing. The diagnosis in MSM is cost effective in all settings, but especially using Home Self Testing when the individual assumes the cost of testing. Conclusions This study illustrates the trade-offs between economic and test efficiency and their interactions with population(s) prevalence. The efficient testing regimes and settings are presently under or not funded in Australia. Home Self Testing has the potential to dramatically increase testing rates at very little cost.

Implementation of a campus-based and peer-delivered HIV self-testing intervention to improve the uptake of HIV testing services among university students in Zimbabwe: the SAYS initiative

“…The efficacy of deliberately organized and advertised HIVST programs has previously been proved to yield positive results in youths [ 19 , 47 , 48 ]. Using trained kit distributers like Peer Educators in program implementation offered individual support and reduced clinical service demands and allowed clinicians to focus their expertise on complex case management [ 49 ]. Disconnecting testing from clinical facility settings and reducing interactions with health providers was predicted to diminish negative perceptions associated with HIV testing experiences [ 31 ].…”

Online HIV Self-Testing (HIVST) Dissemination by an Australian Community Peer HIV Organisation: A Scalable Way to Increase Access to Testing, Particularly for Suboptimal Testers

“…Partnerships with PLHIV and those at risk are central to understanding how HIVST kits can be added to the existing suite of HIV testing modalities to facilitate testing uptake among those not testing or accessing other testing options. This peer-supported model also has health economic value, reducing clinical service demands and redirecting clinicians’ time and expertise to complex case management [ 24 ]. This study does, however, have some limitations.…”

“…HIV self-testing (HIVST) provides convenience and privacy for the person testing [ 17 ], and offers additional opportunities to address identified barriers to testing [ 12 , 15 , 18 , 19 ]—especially when appropriately targeted to at-risk populations [ 20 ] and combined with peer-based support [ 21 ]. Mathematical modelling suggests that HIVST will increase access to and uptake of HIV testing if used to complement existing conventional and rapid testing practices [ 22 , 23 ], at very little cost [ 24 ]. A recent Australian randomized controlled trial demonstrated that the availability of HIVST for MSM doubled HIV testing frequency overall, and resulted in a fourfold increase in testing among non-recent HIV testers [ 25 ].…”