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

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.

Keywords: Lesotho; Southern Africa; cluster-randomized trial; cost analysis; human immunodeficiency virus; secondary distribution; self-testing.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Amstutz, Matsela, Lejone, Kopo, Glass and Labhardt.

Figures

Figure 1
Figure 1
Cost item by arm in absolute US$ (A) and proportion of total costs (B).
Figure 2
Figure 2
Sensitivity analyses on the costs per person tested (in 2018 US$).

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