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  • PMID: 28328545 was deleted because it is a duplicate of PMID: 28617733
J Acquir Immune Defic Syndr. 2017 Jul 1;75(3):280-289. doi: 10.1097/QAI.0000000000001373.

Economic Costs and Health-Related Quality of Life Outcomes of HIV Treatment After Self- and Facility-Based HIV Testing in a Cluster Randomized Trial.

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*Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom; †Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; ‡Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom; §Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; and ‖London School of Hygiene and Tropical Medicine, London, United Kingdom.



The scale-up of HIV self-testing (HIVST) in Africa is recommended, but little is known about how this novel approach influences economic outcomes following subsequent antiretroviral treatment (ART) compared with established facility-based HIV testing and counseling (HTC) approaches.


HIV clinics in Blantyre, Malawi.


Consecutive HIV-positive participants, diagnosed by HIVST or facility-based HTC as part of a community cluster-randomized trial (ISRCTN02004005), were followed from initial assessment for ART until 1-year postinitiation. Healthcare resource use was prospectively measured, and primary costing studies undertaken to estimate total health provider costs. Participants were interviewed to establish direct nonmedical and indirect costs over the first year of ART. Costs were adjusted to 2014 US$ and INT$. Health-related quality of life was measured using the EuroQol EQ-5D at each clinic visit. Multivariable analyses estimated predictors of economic outcomes.


Of 325 participants attending HIV clinics for assessment for ART, 265 were identified through facility-based HTC, and 60 through HIVST; 168/265 (69.2%) and 36/60 (60.0%), respectively, met national ART eligibility criteria and initiated treatment. The mean total health provider assessment costs for ART initiation were US$22.79 (SE: 0.56) and US$19.92 (SE: 0.77) for facility-based HTC and HIVST participants, respectively, and was US$2.87 (bootstrap 95% CI: US$1.01 to US$4.73) lower for the HIVST group. The mean total health provider costs for the first year of ART were US$168.65 (SE: 2.02) and US$164.66 (SE: 4.21) for facility-based HTC and HIVST participants, respectively, and comparable between the 2 groups (bootstrap 95% CI: -US$12.38 to US$4.39). EQ-5D utility scores immediately before and one year after ART initiation were comparable between the 2 groups. EQ-5D utility scores 1 year after ART initiation had increased by 0.129 (SE: 0.011) and 0.139 (SE: 0.027) for facility-based HTC and HIVST participants, respectively.


Once HIV self-testers are linked into HIV services, their economic outcomes are comparable to those linking to services after facility-based HTC.

[Indexed for MEDLINE]

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