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Optimal HIV testing strategies to increase HIV diagnosis in South Africa


Author
Johnson et al.

Publication year
2018

Country

Type of approach
Dual

Type of assistance
n/a

Specimen
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Study population
Mixed: Sex workers, men who have sex with men, partners of people living with HIV and general population

Study design
Modelling

Sample size
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UNAIDS HIV prevalence (2017)

Methodology
Mathematical model developed to simulate the impact and cost-effectiveness of different HIV testing strategies in South Africa. The model is calibrated to historic data on levels of HIV prevalence and testing in South Africa. Self-testing is modelled in the context of home-based and antenatal partner testing.

Summary of findings
Over the 2019-39 period, the strategies with the highest yield (numbers on new diagnoses per test) are expected to include testing partners of newly-diagnosed individuals, sex workers, pre-exposure profilaxis users and men who have sex with men, while the strategies with the lowest yield are expected to include home-based and school-based testing. Considering only testing costs associated with the potential new strategies, the incremental cost per life year saved is lowest for MSM testing (US$ 182) and highest for self-testing scenarios (US$ 1935 for partners of pregnant women and US$ 1108 for home-based testing). Biennial home-based testing including a self-testing kit offer would have the greatest impact, increasing levels of HIV diagnosis in adults of 96.7% in 2025, while home-based testing without the self-test kit offer would increase the fraction to 96.2%.

Acceptability
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Acceptability details
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Willingness to pay
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Willingness to pay details
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Sensitivity
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Specificity
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Concordance
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HIV positivity
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Accuracy details
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Social harm
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Linkage to prevention, care and treatment
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