Assessment of the Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries.


Cambiano, V; Ford, D; Mabugu, T; Napierala Mavedzenge, S; Miners, A; Mugurungi, O; Nakagawa, F; Revill, P; Phillips, A; (2015) Assessment of the Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries. The Journal of infectious diseases. ISSN 0022-1899 DOI: 10.1093/infdis/jiv040

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Abstract

 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.  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.  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.  This analysis suggests that introducing self-testing offers some health benefits and may well save costs.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 25767214
Web of Science ID: 359677600009
URI: http://researchonline.lshtm.ac.uk/id/eprint/2138290

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