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

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Author(s)

  • Valentina Cambiano
  • Deborah Ford
  • Travor Mabugu
  • Sue Napierala Mavedzenge
  • Alec Miners
  • Owen Mugurungi
  • Fumiyo Nakagawa
  • Paul Revill
  • Andrew Phillips

Department/unit(s)

Publication details

JournalThe Journal of Infectious Diseases
DateE-pub ahead of print - 12 Mar 2015
DatePublished (current) - 2015
Issue number4
Volume212
Number of pages8
Pages (from-to)570-577
Early online date12/03/15
Original languageEnglish

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.

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