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Reaching absent and refusing individuals during home-based HIV testing through self-testing: a costing perspective

Title
Reaching absent and refusing individuals during home-based HIV testing through self-testing: a costing perspective
Presenter
Lineo Marie Matsela
Authors
L.M. Matsela * (1), A. Amstutz (2,3,4), T.I. Lejone (5), M. Kopo (5), T.R. Glass (2,3), N.D. Labhardt (2,3,4).
Institutions
(1) University of Cape Town, Department of Public Health & Family Medicine, Cape Town, South Africa, (2) Swiss Tropical and Public Health Institute, Department of Medicine, Basel, Switzerland, (3) University of Basel, Basel, Switzerland, (4) University Hospital Basel, Department of Infectious Diseases and Hospital Epidemiology, Basel, Switzerland, (5) SolidarMed, Partnerships for Health, Butha-Buthe, Lesotho

BACKGROUND: In the HOSENG trial (NCT03598686) in 2018, 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%. This study aims to determine the unit costs per person enumerated, eligible for testing, tested and confirmed new HIV+ during the home-based HIV testing with and without secondary distribution of self-tests.
METHODS: We conducted a micro-costing study to estimate the cost of home-based HIV testing with and without 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.
RESULTS: The overall provider cost for delivering the home-based HIV testing with secondary distribution was US$36''481 among the 4174 persons enumerated and 3094 eligible for testing in the intervention villages, compared to US$28''620 for 3642 persons enumerated and 2727 eligible for testing in control. The cost per person eligible for testing was US$11.79 in intervention versus US$10.50 in 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. Cost per person confirmed new HIV+ was US$889.79 in intervention and US$753.17 in control.
CONCLUSIONS: A self-testing strategy yielding high coverage and the optimal integration of the self-test follow-up in the existing health system resulted in low cost of secondary self-test distribution during home-based HIV testing in Lesotho. These results may inform the current large-scale roll-out of HIV self-tests in Africa ' also driven by the COVID-19 pandemic ' and should be taken into account in home-based testing policies in similar settings.