Understanding the cost-utility of implementing HIV self-testing with digital-based supports

Dados Bibliográficos

ID22069491
AutoresBrianna Empringham (0000-0002-1917-1630, University of Ottawa, autor correspondente), Angela Karellis (McGill University), Marta Fernández-Suárez (0000-0002-5661-666X, FIND), Sérgio Carmona (0000-0002-5960-8737, FIND), Nitika Pant Pai (0000-0002-4672-0500, McGill University), Alice Zwerling (0000-0003-1613-8525, University of Ottawa)
Ano2025
Volume12
Páginas1440104-1440104
Data de publicação2025-01-14
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoFrontiers in Public Health (JOURNAL)
Identificadores do periódicoISSN: 2296-2565 • E-ISSN: 2296-2565
EditoraFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2024.1440104
PMID39877919
OpenAlexW4406379701
IdiomaEN
Referências citadas67

Introduction: HIV self-testing (HIVST) is an innovative strategy that has been shown to increase uptake of HIV testing compared to conventional facility-based testing. HIVST implementation with digital-based supports may help facilitate testing accessibility and linkage to care after a reactive self-test. Economic evidence around community-based implementation of HIVST is growing; however, economic evidence around digital-based HIVST approaches remains limited. Methods: We used previously published cost and efficacy data from HIVST interventions, with the specific intervention model differing between scenarios. Digital-based interventions included text messaging campaigns and online websites that promoted uptake and linkage to HIVST care. Community-based interventions included door-to-door distribution, peer-incentivized distribution, and mobile testing units. Using data obtained from the literature, we parameterized a combined Markov and decision analytic model to evaluate the cost-utility of digital-based HIVST implementation across Malawi, South Africa, and Brazil compared to both community-based HIVST and facility-based testing. Results: We found that HIVST was cost-effective compared to facility-based testing in all settings investigated. Our scenarios predicted that digital-based HIVST was associated with an incremental cost in the range of $769-$17,839/DALY (disability-adjusted life year) averted compared to facility-based testing across Malawi, South Africa, and Brazil. Digital-based HIVST cost savings had an incremental cost of $7,300/DALY averted compared to community-based HIVST. The main drivers of cost-utility included HIV test and treatment costs, HIV test-positivity, rates of linkage to care, and antiretroviral therapy (ART) initiation rates. Digital-based supports were associated with an increased cost compared to facility-based testing, but they also had increased utility, which led to favorable cost-utility estimates. Discussion: HIVST with digital supports has the potential to be a highly cost-effective approach, with the potential to make HIV testing more available and accessible, thereby increasing overall uptake and coverage of HIV testing. Digital supports can also support linkage to care, which we have identified as a major driver of cost-utility. Strategies to improve cost-utility include reducing testing costs, targeting key populations with increased rates of HIV test-positivity, and ensuring strong support for linkage to care

Business · Cost effectiveness · Digital health · Economic growth · Economics · Health care · Process management · Psychological intervention · Computer Science · HIV Research and Treatment · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions · Medicine · Nursing