HIV self-testing economic evaluations

While great strides have been made in expanding antiretroviral therapy (ART) coverage and achieving viral suppression, knowledge of HIV status is lagging behind. There are multiple potential solutions to improving knowledge of HIV status, including improving HIV testing algorithms and through the use of HIV self-testing (HIVST). Governments throughout sub-Saharan Africa are currently improving their HIV testing strategies and trying to identify use-cases for HIVST.

HIVST in particular is recognized as an innovative method to increase the proportion of people who know their HIV status, and has been demonstrated to have high accuracy and acceptability. Nationwide distribution of HIVST, however, will largely depend on cost and cost-effectiveness compared to the current standard of care. The cost of HIVST delivery has been found to be higher than routine facility-based HIV testing using rapid, finger stick test with whole blood, mainly driven by HIVST kit cost and additional costs associated with community-based distribution. These high costs may be different depending on the approach to HIVST delivery. We work on these topics in several African countries.

Publications and other documents

Balakasi K, Nichols BE, Mphande M, Stillson C, Khan S, Kalande P, Robson I, Sanena M, Ng’ona K, van Oosterhout JJ, Doi N, Dovel K. Individual- and facility-level factors associated with facility testing among men in Malawi: findings from a representative community survey. Diagnostics (Basel) 2021; 11: 950.

D’elba M, Makhetha MC, Jubilee M, Taole M, Nkomo C, Machinda A, Tlhomola M, Sande LA, Guillen GBG, Corbett EL, Johnson C, Hatzold K, Meyer-Rath G, Terris-Prestholt F. Using HIV self-testing to increase the affordability of community-based HIV testing services: A longitudinal analysis in Lesotho. AIDS 2020; published ahead of print.

Nichols BE, Offorjebe OA, Cele R, Shaba F, Balakasi K, Chivwara M, Hoffman RM, Long LC, Rosen S, Dovel K. Economic evaluation of facility-based HIV self-testing among adult outpatients in Malawi. J Int AIDS Soc 2020;23:e25612.

Dovel K, Shaba F, Nyirenda M, Offorjebe OA, Balakasi K, Phiri K, Nichols B, Tseng CH, Bardon A, Ngona K, Hoffman R. Evaluating the integration of HIV self-testing into low-resource health systems: study protocol for a cluster-randomized control trial from EQUIP Innovations. Trials 2018; 19: 498

Dovel K, Shaba F, Offorjebe OA, Balakasi K, Nyirenda M, Phiri K, Gupta SK, Wong V, Tseng CH, Nichols B, Cele R, Lungu E, Masina T, Coates TJ, Hoffman RM. Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomized trial. Lancet Global Health 2020; 8 (2), e276-e287.