Costs and economies of scale in repeated home-based HIV counselling and testing

Evidence from the ANRS 12249 Treatment as Prevention trial in South Africa

Bibliographic Data

ID4597868
AuthorsMarwân-Al-Qays Bousmah (0000-0001-5346-5184, Centre Population et Développement), Collins Iwuji (0000-0003-2045-1717, University of Sussex), Nonhlanhla Okesola (Africa Health Research Institute), Joanna Orne-Gliemann (0000-0003-0359-4089, Bordeaux Population Health), Deenan Pillay (0000-0003-3640-2573, University College London), François Dabis (0000-0002-1614-8857, Bordeaux Population Health), Joseph Larmarange (0000-0001-7097-700X, Santé, vulnérabilités et relations de genre au Sud), Simon Boyer (0000-0002-7567-5200, Economic & Social Sciences, Health Systems & Medical Informatics), Sylvie Boyer
Year2022
Volume305
Pages115068
Publication date2022-07-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2022.115068
PMID35665689
OpenAlexW4281680406
LanguageEN
References cited29

Universal HIV testing is now recommended in generalised HIV epidemic settings. Although home-based HIV counselling and testing (HB-HCT) has been shown to be effective in achieving high levels of HIV status awareness, little is still known about the cost implications of universal and repeated HB-HCT. We estimated the costs of repeated HB-HCT and the scale economies that can be obtained when increasing the population coverage of the intervention. We used primary data from the ANRS 12249 Treatment as Prevention (TasP) trial in rural South Africa (2012-2016), whose testing component included six-monthly repeated HB-HCT. We relied on the dynamic system generalised method of moments (GMM) approach to produce unbiased short- and long-run estimates of economies of scale, using the number of contacts made by HIV counsellors for HB-HCT as the scale variable. We also estimated the mediating effect of the contact quality - measured as the proportion of HIV tests performed among all contacts eligible for an HIV test - on scale economies. The mean cost (standard deviation) of universal and repeated HB-HCT was $24.2 (13.7) per contact, $1694.3 (1527.8) per new HIV diagnosis, and $269.2 (279.0) per appropriate referral to HIV care. The GMM estimations revealed the presence of economies of scale, with a 1% increase in the number of contacts for HB-HCT leading to a 0.27% decrease in the mean cost. Our results also suggested a significant long-run relationship between mean cost and scale, with a 1% increase in the scale leading to a 0.36% decrease in mean cost in the long run. Overall, we showed that significant cost savings can be made from increasing population coverage. Nevertheless, there is a risk that this gain is made at the expense of quality: the higher the quality of HB-HCT activities, the lower the economies of scale

Cost effectiveness · Developing country · Economic growth · Economics · Economies of scale · Environmental health · Family medicine · Geography · Human immunodeficiency virus (HIV · Population · Referral · Scale (ratio · Sociology · Adolescent Sexual and Reproductive Health · Demography · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine