The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis


Cambiano, Valentina, Johnson, Cheryl C, Hatzold, Karin, Terris-Prestholt, Fern, Maheswaran, Hendy ORCID: 0000-0002-7375-4845, Thirumurthy, Harsha, Figueroa, Carmen, Cowan, Frances M, Sibanda, Euphemia L, Ncube, Getrude et al (show 4 more authors) (2019) The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis. JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 22 (Suppl ). e25243-.

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Abstract

<h4>Introduction</h4>The prevalence of undiagnosed HIV is declining in Africa, and various HIV testing approaches are finding lower positivity rates. In this context, the epidemiological impact and cost-effectiveness of community-based HIV self-testing (CB-HIVST) is unclear. We aimed to assess this in different sub-populations and across scenarios characterized by different adult HIV prevalence and antiretroviral treatment programmes in sub-Saharan Africa.<h4>Methods</h4>The synthesis model was used to address this aim. Three sub-populations were considered for CB-HIVST: (i) women having transactional sex (WTS); (ii) young people (15 to 24 years); and (iii) adult men (25 to 49 years). We assumed uptake of CB-HIVST similar to that reported in epidemiological studies (base case), or assumed people use CB-HIVST only if exposed to risk (condomless sex) since last HIV test. We also considered a five-year time-limited CB-HIVST programme. Cost-effectiveness was defined by an incremental cost-effectiveness ratio (ICER; cost-per-disability-adjusted life-year (DALY) averted) below US$500 over a time horizon of 50 years. The efficiency of targeted CB-HIVST was evaluated using the number of additional tests per infection or death averted.<h4>Results</h4>In the base case, targeting adult men with CB-HIVST offered the greatest impact, averting 1500 HIV infections and 520 deaths per year in the context of a simulated country with nine million adults, and impact could be enhanced by linkage to voluntary medical male circumcision (VMMC). However, the approach was only cost-effective if the programme was limited to five years or the undiagnosed prevalence was above 3%. CB-HIVST to WTS was the most cost-effective. The main drivers of cost-effectiveness were the cost of CB-HIVST and the prevalence of undiagnosed HIV. All other CB-HIVST scenarios had an ICER above US$500 per DALY averted.<h4>Conclusions</h4>CB-HIVST showed an important epidemiological impact. To maximize population health within a fixed budget, CB-HIVST needs to be targeted on the basis of the prevalence of undiagnosed HIV, sub-population and the overall costs of delivering this testing modality. Linkage to VMMC enhances its cost-effectiveness.

Item Type: Article
Uncontrolled Keywords: HIV testing, community-based HIV self-testing, cost-effectiveness, mathematical modelling, HIV, benefits and cost
Depositing User: Symplectic Admin
Date Deposited: 28 Mar 2019 15:21
Last Modified: 19 Jan 2023 00:55
DOI: 10.1002/jia2.25243
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3035228
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