A user costs analysis for HIV testing among rural communities in Malawi
Sande et al.
Type of approach
Type of assistance
UNAIDS HIV prevalence (2017)
9.1 [8.4 - 9.9]
A baseline household survey was conducted in southern Malawi as part of a cluster randomized trial of HIV self-testing. The questionnaire was administered to adults (15-49 years) of randomly selected households (n=5556), of which 25% were randomly allocated an extended HIV testing questionnaire (n=1387). Further, the respondents who reported having at least one HIV test in the preceding 12 months (14%) completed a module on costs associated with their last test (n=749). To estimate the impact of user and service level characteristics on patient expenditures, while accounting costs being censored at $0, a Tobit model was applied.
Summary of findings
59% of respondents had previously accessed HIV testing at a health facility, 29% reported no user costs. Of those reporting costs, the median cost was $2.08: $2.98 for men and $1.39 for women. Both user and service characteristics were important drivers of costs. Overall, individuals who tested at health-care facilities spent twice as much as those who tested within their communities (mobile clinic), with each additional hour spent at the facilities leading to an average of 24% increase in user costs, ceteris paribus.
Willingness to pay
Willingness to pay details
Linkage to prevention, care and treatment