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J Infect Dis. 2015 Aug 15;212(4):570-7. doi: 10.1093/infdis/jiv040. Epub 2015 Mar 12.

Assessment of the Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries.

Author information

1
Research Department of Infection and Population Health.
2
MRC Clinical Trials Unit, University College London.
3
University of Zimbabwe Clinical Research Centre.
4
Women's Global Health Imperative, RTI International, San Francisco, California.
5
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.
6
Ministry of Health and Child Welfare Zimbabwe, Harare.
7
Centre for Health Economics, University of York, United Kingdom.

Abstract

BACKGROUND:

Studies have demonstrated that self-testing for human immunodeficiency virus (HIV) is highly acceptable among individuals and could allow cost savings, compared with provider-delivered HIV testing and counseling (PHTC), although the longer-term population-level effects are uncertain. We evaluated the cost-effectiveness of introducing self-testing in 2015 over a 20-year time frame in a country such as Zimbabwe.

METHODS:

The HIV synthesis model was used. Two scenarios were considered. In the reference scenario, self-testing is not available, and the rate of first-time and repeat PHTC is assumed to increase from 2015 onward, in line with past trends. In the intervention scenario, self-testing is introduced at a unit cost of $3.

RESULTS:

We predict that the introduction of self-testing would lead to modest savings in healthcare costs of $75 million, while averting around 7000 disability-adjusted life-years over 20 years. Findings were robust to most variations in assumptions; however, higher cost of self-testing, lower linkage to care for people whose diagnosis is a consequence of a positive self-test result, and lower threshold for antiretroviral therapy eligibility criteria could lead to situations in which self-testing is not cost-effective.

CONCLUSIONS:

This analysis suggests that introducing self-testing offers some health benefits and may well save costs.

KEYWORDS:

HIV; cost-effectiveness; diagnostic; mathematical modeling; self-testing

PMID:
25767214
PMCID:
PMC4512606
DOI:
10.1093/infdis/jiv040
[Indexed for MEDLINE]
Free PMC Article

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