scholarly journals The cost and intermediary cost-effectiveness of oral HIV self-test kit distribution across 11 distribution models in South Africa

2021 ◽  
Vol 6 (Suppl 4) ◽  
pp. e005019
Author(s):  
Katleho Matsimela ◽  
Linda Alinafe Sande ◽  
Cyprian Mostert ◽  
Mohammed Majam ◽  
Jane Phiri ◽  
...  
Keyword(s):  
South Africa ◽  
People Living With Hiv ◽  
Distribution Models ◽  
Integration Model ◽  
Sex Worker ◽  
Time And Motion ◽  
Self Testing ◽  
Test Kit ◽  
Self Test ◽  
The Cost

BackgroundCountries around the world seek innovative ways of closing their remaining gaps towards the target of 95% of people living with HIV (PLHIV) knowing their status by 2030. Offering kits allowing HIV self-testing (HIVST) in private might help close these gaps.MethodsWe analysed the cost, use and linkage to onward care of 11 HIVST kit distribution models alongside the Self-Testing AfRica Initiative’s distribution of 2.2 million HIVST kits in South Africa in 2018/2019. Outcomes were based on telephonic surveys of 4% of recipients; costs on a combination of micro-costing, time-and-motion and expenditure analysis. Costs were calculated from the provider perspective in 2019 US$, as incremental costs in integrated and full costs in standalone models.ResultsHIV positivity among kit recipients was 4%–23%, with most models achieving 5%–6%. Linkage to confirmatory testing and antiretroviral therapy (ART) initiation for those screening positive was 19%–78% and 2%–72% across models. Average costs per HIVST kit distributed varied between $4.87 (sex worker model) and $18.07 (mobile integration model), with differences largely driven by kit volumes. HIVST kit costs (at $2.88 per kit) and personnel costs were the largest cost items throughout. Average costs per outcome increased along the care cascade, with the sex worker network model being the most cost-effective model across metrics used (cost per kit distributed/recipient screening positive/confirmed positive/initiating ART). Cost per person confirmed positive for HIVST was higher than standard HIV testing.ConclusionHIV self-test distribution models in South Africa varied widely along four characteristics: distribution volume, HIV positivity, linkage to care and cost. Volume was highest in models that targeted public spaces with high footfall (flexible community, fixed point and transport hub distribution), followed by workplace models. Transport hub, workplace and sex worker models distributed kits in the least costly way. Distribution via index cases at facility as well as sex worker network distribution identified the highest number of PLHIV at lowest cost.

scholarly journals Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe

2021 ◽  
Vol 6 (Suppl 4) ◽  
pp. e005191
Author(s):  
Linda Alinafe Sande ◽  
Katleho Matsimela ◽  
Lawrence Mwenge ◽  
Collin Mangenah ◽  
Augustine Talumba Choko ◽  
...  
Keyword(s):  
Public Health ◽  
South Africa ◽  
Hiv Testing ◽  
Health Facilities ◽  
Public Health Facilities ◽  
Time And Motion ◽  
Self Testing ◽  
Secondary Distribution ◽  
Facility Level ◽  
The Cost

IntroductionAs countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner’s use) distribution alone or primary (own use) and secondary distribution approaches.MethodsWe evaluated the costs of adding HIVST to existing HIV testing from the providers’ perspective in the 31 public health facilities across the four countries between 2018 and 2019. We combined expenditure analysis and bottom-up costing approaches. We also carried out time-and-motion studies on the counsellors to estimate the human resource costs of introducing and demonstrating how to use HIVST for primary and secondary use.ResultsA total of 41 720 kits were distributed during the analysis period, ranging from 1254 in Zimbabwe to 27 678 in Zambia. The cost per kit distributed through the primary distribution approach was $4.27 in Zambia and $9.24 in Zimbabwe. The cost per kit distributed through the secondary distribution approach ranged from $6.46 in Zambia to $13.42 in South Africa, with a wider variation in the average cost at facility-level. From the time-and-motion observations, the counsellors spent between 20% and 44% of the observed workday on HIVST. Overall, personnel and test kit costs were the main cost drivers.ConclusionThe average costs of distributing HIVST kits were comparable across the four countries in our analysis despite wide cost variability within countries. We recommend context-specific exploration of potential efficiency gains from these facility-level cost variations and demand creation activities to ensure continued affordability at scale.

scholarly journals What Should the Ideal HIV Self-Test Look Like? A Usability Study of Test Prototypes in Unsupervised HIV Self-Testing in Kenya, Malawi, and South Africa

2014 ◽  
Vol 18 (S4) ◽  
pp. 422-432 ◽  
Author(s):  
Roger B. Peck ◽  
Jeanette M. Lim ◽  
Heidi van Rooyen ◽  
Wanjiru Mukoma ◽  
Lignet Chepuka ◽  
...  
Keyword(s):  
South Africa ◽  
Usability Study ◽  
Self Testing ◽  
Self Test ◽  
The Ideal

scholarly journals Level of knowledge, acceptability, and willingness to use oral fluid HIV self-testing among medical students in Kilimanjaro region, Tanzania: a descriptive cross-sectional study

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Proches Arobogast Vara ◽  
Luyeye Sostenes Buhulula ◽  
Fatma Aziz Mohammed ◽  
Bernard Njau
Keyword(s):  
Medical Students ◽  
Oral Fluid ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Self Testing ◽  
Test Kit ◽  
Level Of Knowledge ◽  
Self Test ◽  
High Level ◽  
Willingness To Use

Abstract Background HIV Self-Testing (HIVST) is universally accepted as an innovative strategy complimenting existing HIV testing services to archive the UNAIDS, 95-95-95 goals by 2030. However, the adoption of HIVST is lagging in most sub-Saharan countries, including Tanzania. This study aimed to determine the level of knowledge, acceptability, and willingness to use HIVST among Medical students in Kilimanjaro region, Tanzania. Methods A descriptive cross-sectional study using a self-administered, semi-structured questionnaire was conducted from May to June 2019 among 271 medical students aged 18–44 years enrolled in a degree of Medicine course at Kilimanjaro Christian Medical University College. Results A total of 271 participants were enrolled (response rate of 100%). The mean age was 23.9 (SD 2.9), the majority (91%) were Christians, being single (92%), and a half (50.2%) were males. More than half (55.7%) was sexually active, 67.5% reported the age of first sexual debut at 19 years and above. The majority (81.5%) reported that they had one sexual partner, 37% used condoms during the last sexual act. The majority (98.7%) had never had a sexually transmitted disease during the past 3 months, 22.5% reported using alcohol when having sex. More than three-quarters (79%) ever tested for HIV, and 41.6% tested for HIV in the past year. More than two-thirds (67.9%) had a high level of knowledge on oral fluid HIV self-test. Being a female was related with high level of knowledge (P = 0.225). The acceptability of HIVST was 62.7%, and about two-thirds showed a willingness to buy a self-test kit if available for public use. Conclusions The high level of knowledge on oral fluid HIV self-testing, acceptability and willingness to buy self-test kit if available for public use among sexually active medical students underscores the importance of introducing HIVST as a complementary approach for existing HIV testing services in this setting. To make HIVST effective, interventionist should address concerns associated with self-testing, such as lack of pre and post-test counseling, suicidal risks after receiving HIV positive results, perceived risks of inaccurate HIVST test results, lack of linkage to care of individuals receiving HIV positive results, perceived risks of intimate partner violence, coercive testing of a female partner, and perceived high cost of buying self-test kits.

Are women more likely to self-test? A short report from an acceptability study of the HIV self-testing kit in South Africa

AIDS Care ◽  
2016 ◽  
Vol 29 (3) ◽  
pp. 339-343 ◽  
Author(s):  
Alexandra Spyrelis ◽  
Saira Abdulla ◽  
Sasha Frade ◽  
Tessa Meyer ◽  
Miriam Mhazo ◽  
...  
Keyword(s):  
South Africa ◽  
Short Report ◽  
Self Testing ◽  
Self Test

scholarly journals Operationalizing the distribution of oral HIV self-testing kits to men who have sex with men (MSM) in a highly homophobic environment: the Nigerian experience

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Adekemi Sekoni ◽  
Waimar Tun ◽  
Osasuyi Dirisu ◽  
Temitope Ladi-Akinyemi ◽  
Elizabeth Shoyemi ◽  
...  
Keyword(s):  
Group Discussions ◽  
The Sustainable Development ◽  
Effective Strategies ◽  
Qualitative Survey ◽  
Self Testing ◽  
Test Kit ◽  
Community Skills ◽  
Development Goals ◽  
Self Test ◽  
Sex With Men

Abstract Background Self-care health interventions are innovative approaches for improving health and achieving the sustainable development goals (SDGs). Men who have sex with men (MSM) have been disproportionately affected by Human Immunodeficiency Virus (HIV). In spite of this, stigma from healthcare workers has reportedly prevented MSM from accessing HIV testing in health facilities. This paper explored the operationalization of using key opinion leaders (KOLs) to distribute HIVST (HIV self-test) kits to MSM. This qualitative survey used a combination of in-depth interviews (IDI) with HIVST users and focus group discussions (FGDs) with KOLs to collect data three months after the distribution of the test kits by the KOLs. Thematic analysis of the data was carried out. Result Three themes were generated namely: KOLs serve as a trusted resource to promote and support HIVST for the MSM community; Skills and qualifications required for KOLs to effectively distribute and promote uptake of HIVST; and Effective strategies used to create demand and promote uptake of HIVST. Conclusion This study showed the practical steps involved in operationalizing KOL support system distribution of HIVST that positively influenced the testing experience for the participants irrespective of the HIV status and engagement in care. KOLs are a reliable resource to leverage for ensuring that HIV self-test kit is utilized and HIV positive individuals are linked to treatment and care in homophobic environments.

scholarly journals Reaching Absent and Refusing Individuals During Home-Based HIV Testing Through Self-Testing—at What Cost?

2021 ◽  
Vol 8 ◽  
Author(s):  
Alain Amstutz ◽  
Lineo Matsela ◽  
Thabo Ishmael Lejone ◽  
Mathebe Kopo ◽  
Tracy Renée Glass ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Patient Costs ◽  
Home Based ◽  
Self Testing ◽  
Costing Study ◽  
Secondary Distribution ◽  
Self Test ◽  
The Cost ◽  
Testing Coverage ◽  
Provider Cost

Introduction: In the HOSENG trial (NCT03598686), the secondary distribution of oral self-tests for persons absent or refusing to test during a home-based HIV testing campaign in rural Lesotho resulted in an increase in testing coverage of 21% compared to a testing campaign without secondary distribution. This study aims to determine the per patient costs of both HOSENG trial arms.Method: We conducted a micro-costing study to estimate the cost of home-based HIV testing with (HOSENG intervention arm) and without (HOSENG control arm) secondary self-test distribution from a provider's perspective. A mixture of top-down and bottom-up costing was used. We estimated both the financial and economic per patient costs of each possible testing cascade scenario. The costs were adjusted to 2018 US$.Results: The overall provider cost for delivering the home-based HIV testing with secondary distribution was US$36,481 among the 4,174 persons enumerated and 3,094 eligible for testing in the intervention villages compared to US$28,620 for 3,642 persons enumerated and 2,727 eligible for testing in the control. The cost per person eligible for testing was US$11.79 in the intervention vs. US$10.50 in the control. This difference was mainly driven by the cost of distributed oral self-tests. The cost per person tested was, however, lower in intervention villages (US$15.70 vs. US$22.15) due to the higher testing coverage achieved through self-test distribution. The cost per person confirmed new HIV+ was US$889.79 in the intervention and US$753.17 in the control.Conclusion: During home-based HIV testing in Lesotho, the secondary distribution of self-tests for persons absent or refusing to test during the visit reduced the costs per person tested and thus presents a promising add-on for such campaigns.Trial Registration:https://ClinicalTrials.gov/, identifier: NCT03598686

scholarly journals AWARENESS AND WILLINGNESS TO PAY FOR HIV SELF-TEST AMONG MEN WHO HAVE SEX WITH MEN FROM METRO MANILA, PHILIPPINES

2020 ◽  
Vol 20 (1) ◽  
pp. 64-70
Author(s):  
Samuel Brando Piamonte ◽  
Rossana Ditangco
Keyword(s):  
Willingness To Pay ◽  
Voluntary Counseling And Testing ◽  
Counseling And Testing ◽  
Self Testing ◽  
Hiv Test ◽  
Test Kit ◽  
Metro Manila ◽  
Self Test ◽  
Sex With Men ◽  
Saliva Test

Self-testing is a new innovation in HIV testing where one can conduct an HIV test and interpret results discreetly. However, such is not yet available in the Philippine market. This formative study aims to identify the awareness of men who have sex with men (MSM) from Metro Manila, Philippines towards HIV self-testing (HIVST) as well as their willingness to pay for a self-test kit should it be available commercially. Two-hundred fifty MSM who received a non-reactive HIV screening test result from a community-based voluntary counseling and testing center were recruited. Results indicated that there were more respondents who have not heard yet about HIVST. The social media and the internet were the most prominent of source of awareness about it. Frequent testers and being exclusively or more attracted to the same sex are more likely to be aware of HIVST. Median price one is willing to pay is 500 Pesos (roughly 10 US Dollars) and preference for saliva test that blood was reported. Over-all, results implicate that efforts to inform MSM about HIVST should be initiated effectively. Should it be available, HIVST services can also be optimized if done through saliva test and are provided at low price.

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