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Cost-effectiveness of community-based HIV self-testing in Blantyre, Malawi


Author
Maheswaran et al.

Publication year
2017

Country

Type of approach
Community-based

Type of assistance
n/a

Specimen
n/a

Study population
General population: 58% female; mean age 30 years

Study design
Modelling

Sample size
5000

UNAIDS HIV prevalence (2017)

Methodology
In this cost-effectiveness model for HIV testing approaches, the costs of three approaches were compared: standard HIV testing using 2010 WHO guidelines on antiretroviral treatment, standard HIV testing using 2015 WHO guidelines on antiretroviral treatment, and standard HIV testing plus HIV self-testing using either 2010 or 2015 WHO guidelines. Costs and health outcomes were evaluated over a 20-year time horizon, using a discount rate of 3%. Probabilistic sensitivity analysis was conducted to account for parameter uncertainty.

Summary of findings
From the health provider perspective and 20-year time horizon, facility HIV testing and counselling using 2010 WHO ART guidelines was the least costly ($294.71 per person) and least effective (11.64 quality-adjusted life-years per person) strategy. Compared with this strategy, the incremental cost-effectiveness ratio for facility HIV testing and counselling using 2015 WHO ART guidelines was $226.85 per quality-adjusted life year gained. The strategy of facility HIV testing and counselling plus HIV self-testing (HIVST), using 2010 WHO ART guidelines, was extendedly dominated. The incremental cost-effectiveness ratio for facility HIV testing and counselling plus HIVST, using 2015 WHO ART guidelines, was $253.90 per quality-adjusted life year gained compared with facility HIV testing and counselling using 2015 WHO ART guidelines.

Acceptability
n/a

Acceptability details
n/a

Willingness to pay
n/a

Willingness to pay details
n/a

Sensitivity
n/a

Specificity
n/a

Concordance
n/a

HIV positivity
2.3-28.6% (n=n/a)

Accuracy details
n/a

Social harm
n/a

Linkage to prevention, care and treatment
n/a


Study status
Completed