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

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Cambiano, Valentina, Johnson, Cheryl, Hatzold, Karin, Terris-Prestholt, Fern, Maheswaran, Hendy, Thirumurthy, Harsha, Figueroa, Carmen, Cowan, Frances ORCID: https://orcid.org/0000-0003-3087-4422, Sibanda, Euphemia, Ncube, Getrude, Revill, Paul, Baggaley, Rachel C, Corbett, Liz and Phillips, Andrew (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.

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Abstract

Introduction: 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 (CBHIVST) 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.
Methods: 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. Costeffectiveness 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.
Results: 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.
Conclusions: 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.
Keywords: HIV testing, community-based HIV self-testing; cost-effectiveness; mathematical modelling; HIV; benefits and cost

Item Type: Article
Subjects: QS Anatomy > QS 4 General works. Classify here works on regional anatomy
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
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): https://doi.org/10.1002/jia2.25243
Depositing User: Stacy Murtagh
Date Deposited: 28 Mar 2019 13:15
Last Modified: 28 Mar 2019 13:15
URI: http://archive.lstmed.ac.uk/id/eprint/10379

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