Costs of distributing HIV self-testing kits in Eswatini through community and workplace models
© 2024. The Author(s)..
BACKGROUND: This study evaluates the implementation and running costs of an HIV self-testing (HIVST) distribution program in Eswatini. HIVST kits were delivered through community-based and workplace models using primary and secondary distribution. Primary clients could self-test onsite or offsite. This study presents total running economic costs of kit distribution per model between April 2019 and March 2020, and estimates average cost per HIVST kit distributed, per client self-tested, per client self-tested reactive, per client confirmed positive, and per client initiating antiretroviral therapy (ART).
METHODS: Distribution data and follow-up phone interviews were analysed to estimate implementation outcomes. Results were presented for each step of the care cascade using best-case and worst-case scenarios. A top-down incremental cost-analysis was conducted from the provider perspective using project expenditures. Sensitivity and scenario analyses explored effects of economic and epidemiological parameters on average costs.
RESULTS: Nineteen thousand one hundred fifty-five HIVST kits were distributed to 13,031 individuals over a 12-month period, averaging 1.5 kits per recipient. 83% and 17% of kits were distributed via the community and workplace models, respectively. Clients reached via the workplace model were less likely to opt for onsite testing than clients in the community model (8% vs 29%). 6% of onsite workplace testers tested reactive compared to 2% of onsite community testers. Best-case scenario estimated 17,458 (91%) clients self-tested, 633 (4%) received reactive-test results, 606 (96%) linked to confirmatory testing, and 505 (83%) initiated ART. Personnel and HIVST kits represented 60% and 32% of total costs, respectively. Average costs were: per kit distributed US$17.23, per client tested US$18.91, per client with a reactive test US$521.54, per client confirmed positive US$550.83, and per client initiating ART US$708.60. Lower rates for testing, reactivity, and linkage to care in the worst-case scenario resulted in higher average costs along the treatment cascade.
CONCLUSION: This study fills a significant evidence gap regarding costs of HIVST provision along the client care cascade in Eswatini. Workplace and community-based distribution of HIVST accompanied with effective linkage to care strategies can support countries to reach cascade objectives.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
|---|---|
| Enthalten in: |
BMC infectious diseases - 22(2024), Suppl 1 vom: 29. Feb., Seite 976 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
McGee, Kathleen [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Community |
|---|
| Anmerkungen: |
Date Completed 04.03.2024 Date Revised 20.04.2024 published: Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1186/s12879-023-08694-y |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM369144317 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM369144317 | ||
| 003 | DE-627 | ||
| 005 | 20240420232315.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240301s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1186/s12879-023-08694-y |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1381.xml |
| 035 | |a (DE-627)NLM369144317 | ||
| 035 | |a (NLM)38424538 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a McGee, Kathleen |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Costs of distributing HIV self-testing kits in Eswatini through community and workplace models |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 04.03.2024 | ||
| 500 | |a Date Revised 20.04.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024. The Author(s). | ||
| 520 | |a BACKGROUND: This study evaluates the implementation and running costs of an HIV self-testing (HIVST) distribution program in Eswatini. HIVST kits were delivered through community-based and workplace models using primary and secondary distribution. Primary clients could self-test onsite or offsite. This study presents total running economic costs of kit distribution per model between April 2019 and March 2020, and estimates average cost per HIVST kit distributed, per client self-tested, per client self-tested reactive, per client confirmed positive, and per client initiating antiretroviral therapy (ART) | ||
| 520 | |a METHODS: Distribution data and follow-up phone interviews were analysed to estimate implementation outcomes. Results were presented for each step of the care cascade using best-case and worst-case scenarios. A top-down incremental cost-analysis was conducted from the provider perspective using project expenditures. Sensitivity and scenario analyses explored effects of economic and epidemiological parameters on average costs | ||
| 520 | |a RESULTS: Nineteen thousand one hundred fifty-five HIVST kits were distributed to 13,031 individuals over a 12-month period, averaging 1.5 kits per recipient. 83% and 17% of kits were distributed via the community and workplace models, respectively. Clients reached via the workplace model were less likely to opt for onsite testing than clients in the community model (8% vs 29%). 6% of onsite workplace testers tested reactive compared to 2% of onsite community testers. Best-case scenario estimated 17,458 (91%) clients self-tested, 633 (4%) received reactive-test results, 606 (96%) linked to confirmatory testing, and 505 (83%) initiated ART. Personnel and HIVST kits represented 60% and 32% of total costs, respectively. Average costs were: per kit distributed US$17.23, per client tested US$18.91, per client with a reactive test US$521.54, per client confirmed positive US$550.83, and per client initiating ART US$708.60. Lower rates for testing, reactivity, and linkage to care in the worst-case scenario resulted in higher average costs along the treatment cascade | ||
| 520 | |a CONCLUSION: This study fills a significant evidence gap regarding costs of HIVST provision along the client care cascade in Eswatini. Workplace and community-based distribution of HIVST accompanied with effective linkage to care strategies can support countries to reach cascade objectives | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Community | |
| 650 | 4 | |a Costs and cost analysis | |
| 650 | 4 | |a Eswatini | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a HIV self-testing | |
| 650 | 4 | |a Workplace | |
| 700 | 1 | |a d'Elbée, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Dekova, Ralitza |e verfasserin |4 aut | |
| 700 | 1 | |a Sande, Linda A |e verfasserin |4 aut | |
| 700 | 1 | |a Dube, Lenhle |e verfasserin |4 aut | |
| 700 | 1 | |a Masuku, Sanele |e verfasserin |4 aut | |
| 700 | 1 | |a Dlamini, Makhosazana |e verfasserin |4 aut | |
| 700 | 1 | |a Mangenah, Collin |e verfasserin |4 aut | |
| 700 | 1 | |a Mwenge, Lawrence |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson, Cheryl |e verfasserin |4 aut | |
| 700 | 1 | |a Hatzold, Karin |e verfasserin |4 aut | |
| 700 | 1 | |a Neuman, Melissa |e verfasserin |4 aut | |
| 700 | 1 | |a Meyer-Rath, Gesine |e verfasserin |4 aut | |
| 700 | 1 | |a Terris-Prestholt, Fern |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t BMC infectious diseases |d 2001 |g 22(2024), Suppl 1 vom: 29. Feb., Seite 976 |w (DE-627)NLM11120089X |x 1471-2334 |7 nnns |
| 773 | 1 | 8 | |g volume:22 |g year:2024 |g number:Suppl 1 |g day:29 |g month:02 |g pages:976 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1186/s12879-023-08694-y |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 22 |j 2024 |e Suppl 1 |b 29 |c 02 |h 976 | ||