Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness

Abstract

Although many African countries have achieved high levels of HIV diagnosis, funding constraints have necessitated greater focus on more efficient testing approaches. We compared the impact and cost-effectiveness of several potential new testing strategies in South Africa, and assessed the prospects of achieving the UNAIDS target of 95% of HIV-positive adults diagnosed by 2030. We developed a mathematical model to evaluate the potential impact of home-based testing, mobile testing, assisted partner notification, testing in schools and workplaces, and testing of female sex workers (FSWs), men who have sex with men (MSM), family planning clinic attenders and partners of pregnant women. In the absence of new testing strategies, the diagnosed fraction is expected to increase from 90.6% in 2020 to 93.8% by 2030. Home-based testing combined with self-testing would have the greatest impact, increasing the fraction diagnosed to 96.5% by 2030, and would be highly cost-effective compared to currently funded HIV interventions, with a cost per life year saved (LYS) of $394. Testing in FSWs and assisted partner notification would be cost-saving; the cost per LYS would also be low in the case of testing MSM ($20/LYS) and self-testing by partners of pregnant women ($130/LYS).

Acceptability of oral HIV self-testing among female sex workers in Gaborone, Botswana

“…This is unlike other FSW and high risk groups in the region. [11,30,[37][38][39] This lack of knowledge about the test-kit and the associated anxiety can clearly be addressed by the recommendations made by the FSW themselves in this study, namely to ensure wide (and clear) dissemination of information. Additionally there may be need for implementors to lay a good foundation for the introduction of the self-test kits through awareness campaigns which may in turn affect uptake.…”

Use and awareness of and willingness to self-test for HIV: an analysis of cross-sectional population-based surveys in Malawi and Zimbabwe

“…Since then, multiple evaluations of HIVST in each country have shown community-and facility-based HIVST, as well as partnerdelivered HIVST, to be feasible and effective ways of reaching first-time testers, men, young people, as well as partners of people with HIV [10,[16][17][18][19]. Recent mathematical modelling suggests that HIVST can also be cost-effective with appropriate targeting of men in southern Africa among other priority groups [20,21].…”

Use, awareness and willingness to self-test for HIV: An analysis of cross-sectional population-based surveys in Malawi and Zimbabwe

“…Since then, multiple evaluations of HIVST in each country have shown community-based and facility-based HIVST, as well as partner-delivered HIVST, to be a feasible and effective way to reach first time testers, men, young people, as well as partners of people with HIV [10,[16][17][18][19]. Recent mathematical modelling suggests that, with appropriate targeting toward men in southern Africa among other priority groups, HIVST can also be cost-effective [20,21].…”