In the Journals

HIV self-testing may be cost-effective in low-income countries

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March 31, 2015

The introduction of self-testing for HIV in low-income countries would likely offer health benefits to those communities and may also save costs, according to recent findings.

“Possible advantages of self-testing over more standard [provider-delivered HIV testing and counseling] include greater convenience, confidentiality and empowerment for users,” researchers wrote in the Journal of Infectious Diseases. “Self-testing has potential to reach people who, for a variety of reasons, have chosen not to have an HIV test, using the PHTC option. Its availability may also lead to an increase in the frequency at which individuals choose to test for HIV.”

In the study, researchers evaluated the cost-effectiveness of introducing HIV self-testing in 2015 over a 20-year period in a country such as Zimbabwe. To do so, they used an updated version of the HIV synthesis model — a stochastic model of HIV transmission, disease progression and treatment among heterosexuals — to compare two possible scenarios. The first is a reference scenario in which self-testing was not implemented in 2015 and there is ongoing reliance on PHTC alone. The second is a scenario in which self-testing has been introduced to the general population between the ages of 15 and 65 years starting in 2015. The researchers compared these two scenarios on the basis of costs and health outcomes. The fully-loaded cost of PHTC was assumed to be $9 for a negative test result and $25 for a positive test result, with an average cost of around $10. The fully-loaded cost of self-testing was estimated at $3 per unit.

By 2035, the introduction of self-testing would result in a 7% higher proportion of individuals tested for HIV in the past year vs. the reference scenario (57% vs. 50%). Over the course of 20 years, self-testing would lead to health care savings of $75 million (95% CI, $73 million-$77 million). In terms of health gains, the introduction in self-testing would avoid roughly 7,000 disability-adjusted life years, or DALYs (95% CI, 700-13,000 DALYs averted), over the same period. These findings persisted across most variations in assumptions, but higher cost of self-testing, lower access to care for those diagnosed through a positive self-test, and a lower threshold for antiretroviral therapy eligibility could potentially compromise the cost-effectiveness of self-testing.

Overall, the researchers maintained that these findings support the cost-effectiveness and potential cost savings of self-testing in low-income countries.

“Under these assumptions, self-testing should be made available even in settings where resource-constraints are greatest,” the researchers wrote.  “Notably, in some circumstances, it may be necessary to target self-testing to individuals who have certain risk factors.” – by Jennifer Byrne

Disclosure: Cambiano reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

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