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Economic cost analysis of door-to-door community-based distribution of HIV self-test kits in Malawi, Zambia and Zimbabwe
- Source :
- Journal of the International AIDS Society. March 15, 2019, Vol. 22 Issue S1, p74, 8 p.
- Publication Year :
- 2019
-
Abstract
- Introduction: HIV self-testing (HIVST) is recommended by the World Health Organization in addition to other testing modalities to increase uptake of HIV testing, particularly among harder-to-reach populations. This study provides the first empirica evidence of the costs of door-to-door community-based HIVST distribution in Malawi, Zambia and Zimbabwe. Methods: HIVST kits were distributed door-to-door in 71 sites across Malawi, Zambia and Zimbabwe from June 2016 to May 2017. Programme expenditures, supplemented by on-site observation and monitoring and evaluation data were used to estimate total economic and unit costs of HIVST distribution, by input and site. Inputs were categorized into start-up, capital and recurrent costs. Sensitivity and scenario analyses were performed to assess the impact of key parameters on unit costs. Results: In total, 152,671, 103,589 and 93,459 HIVST kits were distributed in Malawi, Zambia and Zimbabwe over 12, 11 and 10 months respectively. Across these countries, 43% to 51% of HIVST kits were distributed to men. The average cost per HIVST kit distributed was US$8.15, US$16.42 and US$13.84 in Malawi, Zambia and Zimbabwe, respectively, with pronounced intersite variation within countries driven largely by site-level fixed costs. Site-level recurrent costs were 70% to 92% of full costs and 20% to 62% higher than routine HIV testing services (HTS) costs. Personnel costs contributed from 26% to 52% of total costs across countries reflecting differences in remuneration approaches and country GDP. Conclusions: These early door-to-door community HIVST distribution programmes show large potential, both for reaching untested populations and for substantial economies of scale as HIVST programmes scale-up and mature. From a societal perspective, the costs of HIVST appear similar to conventional HTS, with the higher providers' costs substantially offsetting user costs. Future approaches to minimizing cost and/or maximize testing coverage could include unpaid door-to-door community-led distribution to reach end-users and integrating HIVST into routine clinical services via direct or secondary distribution strategies with lower fixed costs. Keywords: HIV self-testing; costs and cost analysis; community; Malawi; Zambia; Zimbabwe<br />1 | INTRODUCTION In East and Southern Africa, freely available HIV services have led to a 42% reduction in AIDS-related deaths between 2010 and 2016. Despite such gains, 24% of [...]
- Subjects :
- Health care costs -- Economic aspects
HIV tests -- Usage
Health
Subjects
Details
- Language :
- English
- ISSN :
- 17582652
- Volume :
- 22
- Issue :
- S1
- Database :
- Gale General OneFile
- Journal :
- Journal of the International AIDS Society
- Publication Type :
- Academic Journal
- Accession number :
- edsgcl.583695413
- Full Text :
- https://doi.org/10.1002/jia2.25255