Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States

Shrestha, Ram K.; Chavez, Pollyanna R; Noble, Meredith; Sansom, Stephanie L.; Sullivan, Patrick S.; Mermin, Jonathan; MacGowan, Robin J.

doi:10.1002/jia2.25445

Cited by 47 publications

(48 citation statements)

References 29 publications

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“…The only comparative self-testing cost study is one which recently reported in the U.S. and has shown comparable values to those reported here [ 27 ]. The U.S. values were $US61 per self-test completed; and an incremental cost per new HIV diagnosis of $US9365 [ 27 ].…”

Section: Discussionsupporting

confidence: 82%

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

Williams

Dean

Crothers

et al. 2021

BMC Health Serv Res

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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.

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Section: Discussionsupporting

confidence: 82%

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

Williams

Dean

Crothers

et al. 2021

BMC Health Serv Res

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“…The implementation of free distribution of HIVST may promote the increase of testing frequency among high-risk MSM [48]. Moreover, it has been considering as a cost-effective prevention technology [49,50].…”

Section: Discussionmentioning

confidence: 99%

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

Magno

Leal

Knauth

et al. 2020

Preprint

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Background : Brazil has a substantial population living with HIV (PLWH) who are still unaware of their serostatus and has recently added HIV self-test (HIVST) into its public health system for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and its associated factors among those who had never been tested or had a previous HIV negative result. Methods : Respondent-driven sampling (RDS) was used for behavioral and biological surveillance to recruit 4,176 MSM in 12 Brazilian cities in 2016. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). Results : We included 3,605 MSM who did not previously know they were PLWH. The acceptability of HIVST was 49.1%, lower among those had never tested compared to those who had a previous HIV negative test. In the subgroup of MSM who had never had an HIV test, those who reported discrimination and who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous HIV negative test, only those reporting condomless receptive anal sex had greater HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in LGBT nongovernmental organizations, and complete secondary or incomplete higher school were associated with greater acceptability in both groups. Conclusions : The findings highlight that it is necessary to improve information about HIVST among the most vulnerable MSM in Brazil. Given the acceptability of self-testing and its current promotion in Brazil, we can also point to the need for policies that build on this and enhance timely access to health services and prevention information.

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“…The implementation of HIVST to free distribution and as a public health policy may promote the increase of testing frequency among high-risk MSM [36]. Moreover, it has been considering as a technology with good costeffectiveness [37,38].…”

Section: Discussionmentioning

confidence: 99%

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

Magno

Leal

Knauth

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Brazil has a lot of people living with HIV (PLWH) that are still unaware of their own serostatus and has recently integrated HIV self-test (HIVST) into its public health system and offered to key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and its associated factors. Methods: Respondent-driven sampling (RDS) was used in behavioral and biological surveillance to recruit 4,176 MSM in 12 Brazilian cities in 2016. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted according to Gile’s estimator using RDS Analyst Software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or at least once in a lifetime). Results: We included 3,605 MSM who did not previously know they were PLWH. The HIVST acceptability was 49.1%, lower among those had done HIV test during lifetime compared to those who have never done it (42.7% vs 50.1%), especially among who are in a less vulnerable social context. In the subgroups of MSM who had never had an HIV test, those with complete secondary or incomplete higher school, who reported discrimination, who with a medical appointment in the last 12 months, with high levels of knowledge of HIV/AIDS and who took part in LGBT nongovernmental organization (LGBT-NGO) had higher HIVST acceptability. Among MSM who had taken an HIV test, those who took part in LGBT NGOs had greater HIVST acceptability. We observed a dose-response effect of schooling and knowledge of HIV/AIDS on HIVST acceptability: an increase in both levels was associated with greater acceptability. Conclusions: The findings highlight that it is necessary to improve information about HIVST among MSM more vulnerable in Brazil. Given the acceptability of self-testing and its current adoption in Brazil, we can also point to the need for policies that build on this and enhance timely access to health services and prevention information.

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Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States

Cited by 47 publications

References 29 publications

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

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

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

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