Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe

Sande, Linda Alinafe, Matsimela, Katleho, Mwenge, Lawrence, Mangenah, Collin, Talumba Choko, Augustine, d'Elbée, Marc, Majam, Mohammed, Mostert, Cyprian, Matamwandi, Inonge, Sibanda, Euphemia ORCID: https://orcid.org/0000-0003-1754-1076, Johnson, Cheryl, Hatzold, Karin, Ayles, Helen, Cowan, Frances ORCID: https://orcid.org/0000-0003-3087-4422, Corbett, Elizabeth Lucy, Neuman, Melissa, Maheswaran, Hendramoorthy, Meyer-Rath, Gesine and Terris-Prestholt, Fern (2021) 'Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe'. BMJ Global Health, Vol 6, Issue Suppl 4, e005191.

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Abstract

Introduction
As countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner’s use) distribution alone or primary (own use) and secondary distribution approaches.

Methods
We evaluated the costs of adding HIVST to existing HIV testing from the providers’ perspective in the 31 public health facilities across the four countries between 2018 and 2019. We combined expenditure analysis and bottom-up costing approaches. We also carried out time-and-motion studies on the counsellors to estimate the human resource costs of introducing and demonstrating how to use HIVST for primary and secondary use.

Results
A total of 41 720 kits were distributed during the analysis period, ranging from 1254 in Zimbabwe to 27 678 in Zambia. The cost per kit distributed through the primary distribution approach was $4.27 in Zambia and $9.24 in Zimbabwe. The cost per kit distributed through the secondary distribution approach ranged from $6.46 in Zambia to $13.42 in South Africa, with a wider variation in the average cost at facility-level. From the time-and-motion observations, the counsellors spent between 20% and 44% of the observed workday on HIVST. Overall, personnel and test kit costs were the main cost drivers.

Conclusion
The average costs of distributing HIVST kits were comparable across the four countries in our analysis despite wide cost variability within countries. We recommend context-specific exploration of potential efficiency gains from these facility-level cost variations and demand creation activities to ensure continued affordability at scale.

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):	https://doi.org/10.1136/bmjgh-2021-005191
Depositing User:	Rachel Dominguez
Date Deposited:	22 Jul 2021 14:23
Last Modified:	30 Jul 2021 14:35
URI:	https://archive.lstmed.ac.uk/id/eprint/18381

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