Assessment of the Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries.
Cambiano, Valentina;
Ford, Deborah;
Mabugu, Travor;
Napierala Mavedzenge, Sue;
Miners, Alec;
Mugurungi, Owen;
Nakagawa, Fumiyo;
Revill, Paul;
Phillips, Andrew;
(2015)
Assessment of the Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries.
The Journal of infectious diseases, 212 (4).
pp. 570-577.
ISSN 0022-1899
DOI: https://doi.org/10.1093/infdis/jiv040
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BACKGROUND: Studies have demonstrated that self-testing for human immunodeficiency virus (HIV) is highly acceptable among individuals and could allow cost savings, compared with provider-delivered HIV testing and counseling (PHTC), although the longer-term population-level effects are uncertain. We evaluated the cost-effectiveness of introducing self-testing in 2015 over a 20-year time frame in a country such as Zimbabwe. METHODS: The HIV synthesis model was used. Two scenarios were considered. In the reference scenario, self-testing is not available, and the rate of first-time and repeat PHTC is assumed to increase from 2015 onward, in line with past trends. In the intervention scenario, self-testing is introduced at a unit cost of $3. RESULTS: We predict that the introduction of self-testing would lead to modest savings in healthcare costs of $75 million, while averting around 7000 disability-adjusted life-years over 20 years. Findings were robust to most variations in assumptions; however, higher cost of self-testing, lower linkage to care for people whose diagnosis is a consequence of a positive self-test result, and lower threshold for antiretroviral therapy eligibility criteria could lead to situations in which self-testing is not cost-effective. CONCLUSIONS: This analysis suggests that introducing self-testing offers some health benefits and may well save costs.