Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe
| Autor: | Fern Terris-Prestholt, Lawrence Mwenge, Marc d'Elbée, Euphemia L Sibanda, Helen Ayles, Mohammed Majam, Elizabeth L. Corbett, Linda Sande, Frances M. Cowan, Cheryl Johnson, Melissa Neuman, Augustine T. Choko, Karin Hatzold, Cyprian M. Mostert, Katleho Matsimela, Inonge Matamwandi, Gesine Meyer-Rath, Collin Mangenah, Hendramoorthy Maheswaran |
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| Rok vydání: | 2021 |
| Předmět: |
Zimbabwe
medicine.medical_specialty Medicine (General) Malawi Zambia HIV Infections Infectious and parasitic diseases RC109-216 diagnostics and tools South Africa R5-920 Acquired immunodeficiency syndrome (AIDS) Environmental health medicine Humans Mass Screening health economics Human resources Activity-based costing Average cost Original Research Health economics business.industry Health Policy Public health public health Public Health Environmental and Occupational Health HIV medicine.disease AIDS Self-Testing Cost driver Scale (social sciences) Health Facilities business |
| Zdroj: | BMJ Global Health BMJ Global Health, Vol 6, Iss Suppl 4 (2021) |
| ISSN: | 2059-7908 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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