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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: https://orcid.org/0000-0003-1754-1076, Neuman, Melissa, Ncube, Getrude, Ong, Jason J, Mugurungi, Owen, Hatzold, Karin, Johnson, Cheryl, Ayles, Helen, Corbett, Elizabeth L, Cowan, Frances ORCID: https://orcid.org/0000-0003-3087-4422, 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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jia2_25255_Rev_EV.pdf - Published Version Available under License Creative Commons Attribution. Download (327kB) | Preview |
Abstract
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): | https://doi.org/10.1002/jia2.25255 |
| Depositing User: | Stacy Murtagh |
| Date Deposited: | 25 Mar 2019 16:18 |
| Last Modified: | 07 Oct 2019 07:36 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/10378 |
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