Economic evaluation of facility‐based HIV self‐testing among adult outpatients in Malawi

Nichols, Brooke E; Offorjebe, Ogechukwu Agatha; Cele, Refiloe; Shaba, Frackson; Balakasi, Kelvin; Chivwara, Mackenzie; Hoffman, Risa M.; Long, Lawrence; Rosen, Sydney; Dovel, Kathryn

doi:10.1002/jia2.25612

Cited by 15 publications

(32 citation statements)

References 13 publications

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“…Sixteen studies reported on cost in terms of implementation or cost-effectiveness. In African countries, offering HIV-ST generally increased total program costs or cost per person tested compared to standard HIV testing [25,145,204,[213][214][215][216][217][218] due to the higher cost of the testing kit and the added cost from strategies to promote adoption. For example, Mulubwa et al [145]…”

Section: Implementation Costsmentioning

confidence: 99%

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Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

et al. 2021

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Introduction HIV self-testing (HIV-ST) is an effective means of improving HIV testing rates. Low- and middle-income countries (LMIC) are taking steps to include HIV-ST into their national HIV/AIDS programs but very few reviews have focused on implementation in LMIC. We performed a scoping review to describe and synthesize existing literature on implementation outcomes of HIV-ST in LMIC. Methods We conducted a systematic search of Medline, Embase, Global Health, Web of Science, and Scopus, supplemented by searches in HIVST.org and other grey literature databases (done 23 September 2020) and included articles if they reported at least one of the following eight implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, or sustainability. Both quantitative and qualitative results were extracted and synthesized in a narrative manner. Results and discussion Most (75%) of the 206 included articles focused on implementation in Africa. HIV-ST was found to be acceptable and appropriate, perceived to be convenient and better at maintaining confidentiality than standard testing. The lack of counselling and linkage to care, however, was concerning to stakeholders. Peer and online distribution were found to be effective in improving adoption. The high occurrence of user errors was a common feasibility issue reported by studies, although, diagnostic accuracy remained high. HIV-ST was associated with higher program costs but can still be cost-effective if kit prices remain low and HIV detection improves. Implementation fidelity was not always reported and there were very few studies on, penetration, and sustainability. Conclusions Evidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation. Future research should address equity through measuring penetration and potential barriers to sustainability including distribution, cost, scale-up, and safety.

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Section: Implementation Costsmentioning

confidence: 99%

“…They also found that keeping the price of kits low ensured the cost-effectiveness of the program. Nichols et al [218] found that aside from maintaining kit prices low, ensuring high linkage rates is also important to ensure that HIV-ST programs are cost-saving.…”

Section: Plos Onementioning

confidence: 99%

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

et al. 2021

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“…Each negative test was assumed to require 20-minutes of staff interaction time, and each HIVpositive test to require 50-minutes of staff interaction time. 9 Overall PITC staff time was taken as the summation of person-time for the number of positive and negative tests of the total cohort assigned a PITC test across the 12-month period. From the community representative survey, 15% of individuals refused PITC HIV testing when offered.…”

Section: Pitc Staff Timementioning

confidence: 99%

“…Costs are reported in 2018 USD collected as part of a previous facility-based HIVST trial in Malawi. 8,9…”

Section: Scenario Costing and Cost-effectiveness Analysismentioning

confidence: 99%

“…To calculate the total costs for each scenario we accounted for the full cost of all test kits, including professional-use tests prescribed by Malawi's HIV testing algorithm, Determine HIV 1/2 (Alere), Uni-Gold HIV (Trinity Biotech), and OraQuick HIVST (OraSure), staff time, consumables and overhead estimated from previous work. 8,9 The unit costs for positive and negative tests by modality are presented in Table 1. To determine cost-effectiveness, we calculated the incremental costeffectiveness ratio of each scenario at different HIVST kit prices-given that the kit price can affect the order of scenarios on the cost-effectiveness frontier.…”

Section: Scenario Costing and Cost-effectiveness Analysismentioning

confidence: 99%

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Facility-based HIV self-testing strategies may substantially increase number of men and youth tested for HIV in Malawi: results from a data-driven individual-based model

Nichols

Nooy²,

Benade

et al. 2021

Preprint

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BackgroundMalawi is rapidly closing the gap in achieving the UNAIDS 95-95-95 targets, with 90% of people living with HIV in Malawi aware of their status. As we approach epidemic control, interventions to improve coverage will become more costly. There is therefore an urgent need to identify innovative and low-cost strategies to maintain and increase testing coverage without diverting resources from other HIV services.MethodsA data-driven individual-based model was parameterized with data from a community-representative survey (sociodemographic, health service utilization, HIV testing history) of men and youth in Malawi (data collected 08/2019). 79 different strategies for the implementation of HIV self-testing (HIVST) and provider-initiated-testing-and-counselling at the outpatient department (OPD) were evaluated. Outcomes included percent of men/youth tested for HIV in a 12-month period, cost-effectiveness, and human resource requirements. Testing yield was assumed to be constant across the scenarios.FindingsFacility-based HIVST offered year-round resulted in the greatest increase in proportion of men and youth tested in the OPD (from 45% to 72%-83%), was considered cost-saving for HIVST kit priced at $1.00, and generally reduced required personnel as compared to the status quo. At higher HIVST kit prices, and more relaxed eligibility criteria, all scenarios that considered year-round HIVST in the OPD remained on the cost-effectiveness frontier.InterpretationFacility-based HIVST is a cost-effective strategy to increase the proportion of men/youth tested for HIV and decreases the human resource requirements for HIV testing in the OPD-providing additional health care worker time for other priority health care activities.FundingFCDO; USAID

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Facility‐based HIV self‐testing strategies may substantially and cost‐effectively increase the number of men and youth tested for HIV in Malawi: results from an individual‐based mathematical model

et al. 2022

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Introduction Malawi is rapidly closing the gap in achieving the UNAIDS 95‐95‐95 targets, with 90% of people living with HIV in Malawi aware of their status. As we approach epidemic control, interventions to improve coverage will become more costly. There is, therefore, an urgent need to identify innovative and low‐cost strategies to maintain and increase testing coverage without diverting resources from other HIV services. The objective of this study is to model different combinations of facility‐based HIV testing modalities and determine the most cost‐effective strategy to increase the proportion of men and youth testing for HIV. Methods A data‐driven individual‐based model was parameterized with data from a community‐representative survey (socio‐demographic, health service utilization and HIV testing history) of men and youth in Malawi (data collected August 2019). In total, 79 different strategies for the implementation of HIV self‐testing (HIVST) and provider‐initiated‐testing‐and‐counselling at the outpatient department (OPD) were evaluated. Outcomes included percent of men/youth tested for HIV in a 12‐month period, cost‐effectiveness and human resource requirements. The testing yield was assumed to be constant across the scenarios. Results Facility‐based HIVST offered year‐round resulted in the greatest increase in the proportion of men and youth tested in the OPD (from 45% to 72%–83%), was considered cost‐saving for HIVST kit priced at $1.00, and generally reduced required personnel as compared to the status quo. At higher HIVST kit prices, and more relaxed eligibility criteria, all scenarios that considered year‐round HIVST in the OPD remained on the cost‐effectiveness frontier. Conclusions Facility‐based HIVST is a cost‐effective strategy to increase the proportion of men/youth tested for HIV in Malawi and decreases the human resource requirements for HIV testing in the OPD—providing additional healthcare worker time for other priority healthcare activities.

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Economic evaluation of facility‐based HIV self‐testing among adult outpatients in Malawi

Cited by 15 publications

References 13 publications

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

Facility-based HIV self-testing strategies may substantially increase number of men and youth tested for HIV in Malawi: results from a data-driven individual-based model

Facility‐based HIV self‐testing strategies may substantially and cost‐effectively increase the number of men and youth tested for HIV in Malawi: results from an individual‐based mathematical model

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