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Economic cost analysis of door-to-door community-based distribution of HIV self-test kits in Malawi, Zambia and Zimbabwe


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Mangenah, Collin, Mwenge, Lawrence, Sande, Linda, Ahmed, Nurilign, d’Elbee, Marc, Chiwawa, Progress, Chigwenah, Tariro, Kanema, Sarah, Mutseta, Miriam, Nalubamba, Mutinta, Chilongosi, Richard, Indravudh, Pichaya, Sibanda, Euphemia ORCID:, Neuman, Melissa, Ncube, Getrude, Ong, Jason J, Mugurungi, Owen, Hatzold, Karin, Johnson, Cheryl, Ayles, Helen, Corbett, Elizabeth L, Cowan, Frances ORCID:, Maheswaran, Hendramoorthy and Terris-Prestholt, Fern (2019) 'Economic cost analysis of door-to-door community-based distribution of HIV self-test kits in Malawi, Zambia and Zimbabwe'. Journal of the International AIDS Society, Vol 22, Issue S1, e25255.

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Introduction: HIV self-testing (HIVST) is recommended by the World Health Organization in addition to other testing modalities to increase uptake of HIV testing, particularly among harder-to-reach populations. This study provides the first empirical evidence of the costs of door-to-door community-based HIVST distribution in Malawi, Zambia and Zimbabwe.
Methods: HIVST kits were distributed door-to-door in 71 sites across Malawi, Zambia and Zimbabwe from June 2016 to May 2017. Programme expenditures, supplemented by on-site observation and monitoring and evaluation data were used to estimate total economic and unit costs of HIVST distribution, by input and site. Inputs were categorized into a start-up, capital and recurrent
costs. Sensitivity and scenario analyses were performed to assess the impact of key parameters on unit costs.
Results: In total, 152,671, 103,589 and 93,459 HIVST kits were distributed in Malawi, Zambia and Zimbabwe over 12, 11 and 10 months respectively. Across these countries, 43% to 51% of HIVST kits were distributed to men. The average cost per HIVST kit distributed was US$8.15, US$16.42 and US$13.79 in Malawi, Zambia and Zimbabwe, respectively, with pronounced intersite variation within countries driven largely by site-level fixed costs. Site-level recurrent costs were 70% to 92% of full costs and 20% to 62% higher than routine HIV testing services (HTS) costs. Personnel costs contributed from 26% to 52% of total costs across countries reflecting differences in remuneration approaches and country GDP.
Conclusions: These early door-to-door community HIVST distribution programmes show large potential, both for reaching
untested populations and for substantial economies of scale as HIVST programmes scale-up and mature. From a societal perspective, the costs of HIVST appear similar to conventional HTS, with the higher providers’ costs substantially offsetting user costs. Future approaches to minimizing cost and/or maximize testing coverage could include unpaid door-to-door community led
distribution to reach end-users and integrating HIVST into routine clinical services via direct or secondary distribution
strategies with lower fixed costs.
Keywords: HIV self-testing; costs and cost analysis; community; Malawi; Zambia; Zimbabwe

Item Type: Article
Subjects: W General Medicine. Health Professions > W 74 Medical economics. Health care costs
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Stacy Murtagh
Date Deposited: 25 Mar 2019 16:18
Last Modified: 07 Oct 2019 07:36


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