The potential role of HIV self-testing within pre-exposure prophylaxis implementation
Curran et al.
Type of approach
Type of assistance
Vulnerable population: Serodiscordant couples on pre-exposure prophylaxis
UNAIDS HIV prevalence (2017)
5.9 [4.9 - 7.0]
This study used data from an open-label pre-exposure prophylaxis (PrEP) demonstration project in Kenya to estimate costs for three re-testing approaches during the first year of PrEP use: 1) facility-based HIV testing (re-test every 3 months), 2) directly-assisted HIVST (re-test every 3 months in facility), and 3) unassisted HIVST (alternating unassisted HIVST and facility-based test every 3 months). Costs included commodities, human resources, and 24-hour telephone hotline. In the cost-modelling, several assumptions were made, including 98% enrollment into HIVST, 1% of clients require second HIV test in serial testing algorithm, and 3% and 5% require facility-based re-testing due to positive result or user error (options 2 and 3 respectively).
Summary of findings
When one HIVST kit costs 5 USD, directly-assisted HIVST would be the least expensive annual re-testing approach (80.17 USD/person) due to less counsellor time. Unassisted HIVST is less expensive than facility-based testing when HIVST kit is 3 USD. If 1 USD HIVST kits (e.g. blood-based) are used, annual cost of re-testing per person is 83.27 USD for facility-based testing, 60.57 USD for unassisted HIVST, and 74.01 USD for directly-assisted HIVST pre-exposure prophylaxis demonstration. Projects considering HIVST should evaluate potential advantages, feasibility, acceptability, re-testing frequency, and choice of HIVST kit (e.g. sensitivity and ability to detect acute HIV infection).
Willingness to pay
Willingness to pay details
Linkage to prevention, care and treatment