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

Alain Amstutz*, Lineo Matsela, Thabo Ishmael Lejone, Mathebe Kopo, Tracy Renée Glass, Niklaus Daniel Labhardt

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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

Original languageEnglish
Article number653677
JournalFrontiers in Medicine
Volume8
DOIs
Publication statusPublished - 29 Jun 2021
Externally publishedYes

Keywords

  • Lesotho
  • Southern Africa
  • cluster-randomized trial
  • cost analysis
  • human immunodeficiency virus
  • secondary distribution
  • self-testing

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