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Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counseling in Blantyre, Malawi

Maheswaran et al.

Publication year


Type of approach

Type of assistance
Directly assisted


Study population
General population

Study design

Sample size

UNAIDS HIV prevalence (2017)
9.1 [8.4 - 9.9]

The aim of this study is to investigate whether or not local HIV testing and counseling services will increase knowledge of HIV status and encourage early entry into HIV care leading to fewer new episodes of TB among the entire community. HIV testing will include the option of self-testing for HIV at home and in private. HIV care will be provided through the routine public health services, but with the addition of a drug (isoniazid) provided by the study team to prevent TB.

Summary of findings
A total of 1241 participants underwent either HIVST (n=775) or facility-based HIV testing and counseling (HTC) (n=446). The mean societal cost per participant tested through HIVST (US$9.23; 95% CI: US$9.14-US$9.32) was lower than through facility-based HTC (US$11.84; 95% CI: US$10.81-12.86). Although the mean health-provider cost per participant tested through HIVST (US$8.78) was comparable to facility-based HTC (range: US$7.53-US$10.57), the associated mean direct non-medical and indirect cost was lower (US$2.93; 95 % CI: US$1.90-US$3.96). The mean health-provider cost per HIV-positive participant identified through HIVST was higher (US$97.50) than for health facilities (range: US$25.18-US$76.14), as was the mean cost per HIV-positive individual assessed for antiretroviral therapy (ART) eligibility and the mean cost per HIV-positive individual initiated onto ART.


Acceptability details

Willingness to pay

Willingness to pay details




HIV positivity

Accuracy details

Social harm

Linkage to prevention, care and treatment


Study status

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