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Ahmed N, Ong JJ, McGee K, d'Elbée M, Johnson C, Cambiano V, Hatzold K, Corbett EL, Terris-Prestholt F, Maheswaran H. Costs of HIV testing services in sub-Saharan Africa: a systematic literature review. BMC Infect Dis 2024; 22:980. [PMID: 39192180 DOI: 10.1186/s12879-024-09770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE To review HIV testing services (HTS) costs in sub-Saharan Africa. DESIGN A systematic literature review of studies published from January 2006 to October 2020. METHODS We searched ten electronic databases for studies that reported estimates for cost per person tested ($pptested) and cost per HIV-positive person identified ($ppositive) in sub-Saharan Africa. We explored variations in incremental cost estimates by testing modality (health facility-based, home-based, mobile-service, self-testing, campaign-style, and stand-alone), by primary or secondary/index HTS, and by population (general population, people living with HIV, antenatal care male partner, antenatal care/postnatal women and key populations). All costs are presented in 2019US$. RESULTS Sixty-five studies reported 167 cost estimates. Most reported only $pptested (90%), while (10%) reported the $ppositive. Costs were highly skewed. The lowest mean $pptested was self-testing at $12.75 (median = $11.50); primary testing at $16.63 (median = $10.68); in the general population, $14.06 (median = $10.13). The highest costs were in campaign-style at $27.64 (median = $26.70), secondary/index testing at $27.52 (median = $15.85), and antenatal male partner at $47.94 (median = $55.19). Incremental $ppositive was lowest for home-based at $297.09 (median = $246.75); primary testing $352.31 (median = $157.03); in the general population, $262.89 (median: $140.13). CONCLUSION While many studies reported the incremental costs of different HIV testing modalities, few presented full costs. Although the $pptested estimates varied widely, the costs for stand-alone, health facility, home-based, and mobile services were comparable, while substantially higher for campaign-style HTS and the lowest for HIV self-testing. Our review informs policymakers of the affordability of various HTS to ensure universal access to HIV testing.
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Affiliation(s)
- Nurilign Ahmed
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Melbourne, Australia
| | - Kathleen McGee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Marc d'Elbée
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Cheryl Johnson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | - Karin Hatzold
- Population Services International, Cape Town, South Africa
| | - Elizabeth L Corbett
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Fern Terris-Prestholt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- United Nations Joint Programme on HIV AIDS, Geneva, Switzerland
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Elsbernd K, Emmert-Fees KMF, Erbe A, Ottobrino V, Kroidl A, Bärnighausen T, Geisler BP, Kohler S. Costs and cost-effectiveness of HIV early infant diagnosis in low- and middle-income countries: a scoping review. Infect Dis Poverty 2022; 11:82. [PMID: 35841117 PMCID: PMC9284833 DOI: 10.1186/s40249-022-01006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Continuing progress in the global pediatric human immunodeficiency virus (HIV) response depends on timely identification and care of infants with HIV. As countries scale-out improvements to HIV early infant diagnosis (EID), economic evaluations are needed to inform program design and implementation. This scoping review aimed to summarize the available evidence and discuss practical implications of cost and cost-effectiveness analyses of HIV EID. Methods We systematically searched bibliographic databases (Embase, MEDLINE and EconLit) and grey literature for economic analyses of HIV EID in low- and middle-income countries published between January 2008 and June 2021. We extracted data on unit costs, cost savings, and incremental cost-effectiveness ratios as well as outcomes related to health and the HIV EID care process and summarized results in narrative and tabular formats. We converted unit costs to 2021 USD for easier comparison of costs across studies. Results After title and abstract screening of 1278 records and full-text review of 99 records, we included 29 studies: 17 cost analyses and 12 model-based cost-effectiveness analyses. Unit costs were 21.46–51.80 USD for point-of-care EID tests and 16.21–42.73 USD for laboratory-based EID tests. All cost-effectiveness analyses stated at least one of the interventions evaluated to be cost-effective. Most studies reported costs of EID testing strategies; however, few studies assessed the same intervention or reported costs in the same way, making comparison of costs across studies challenging. Limited data availability of context-appropriate costs and outcomes of children with HIV as well as structural heterogeneity of cost-effectiveness modelling studies limits generalizability of economic analyses of HIV EID. Conclusions The available cost and cost-effectiveness evidence for EID of HIV, while not directly comparable across studies, covers a broad range of interventions and suggests most interventions designed to improve EID are cost-effective or cost-saving. Further studies capturing costs and benefits of EID services as they are delivered in real-world settings are needed. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-01006-7.
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Affiliation(s)
- Kira Elsbernd
- Division of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Ludwig Maximilians University, Munich, Germany. .,Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, Ludwig Maximilian University, Munich, Germany.
| | - Karl M F Emmert-Fees
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Amanda Erbe
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Veronica Ottobrino
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Ludwig Maximilians University, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site, Munich, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Benjamin P Geisler
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, Ludwig Maximilian University, Munich, Germany.,Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Lin B, Liu J, Ma Y, Zhong X. Factors influencing HIV testing and counselling services among men who have sex with men in Western China: a cross-sectional study based on Andersen’s Behavioral Model. Environ Health Prev Med 2022; 27:21. [PMID: 35644545 PMCID: PMC9251615 DOI: 10.1265/ehpm.22-00066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Men who have sex with men (MSM), as a marginal population, has been largely ignored by health service projects. We assessed the utilization of HIV testing and counselling services and its influencing factors based on Andersen’s Behavioral Model, so as to provide a theoretical basis for future infectious disease prevention and control strategies and health services policy formulation for these population. Method This was a cross-sectional study. A sample survey was conducted in Western China, and an anonymous self-administered questionnaire survey was conducted among MSM. Based on Andersen’s Behavioral Model, the questionnaire divided the influencing factors into predisposing factor, enabling factor and need factor. Multivariate logistic regression analysis was used to explore the factors influencing the utilization of HIV testing and counselling. Results There were 3184 valid questionnaires. In the survey of HIV health services, 82.85% MSM had HIV testing and 64.98% MSM had HIV counselling, respectively. Among the predisposing factor, age 25 years old and over was a facilitator of HIV testing and counselling, and ethnicity was a factor associated with HIV testing. Among the enabling factor, MSM living in urban were more likely to have access to testing and counselling services, and income was also linked to HIV testing. Among the need factor, a high level of HIV knowledge could promote testing and counselling, and a history of sexually transmitted diseases (STD) was a facilitator of testing. Conclusions HIV testing is widespread in Western China and higher than counselling service. MSM with high-risk characteristics should be identified as a priority in the future public health services.
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Affiliation(s)
- Bing Lin
- School of Public Health and Management, Research Center for Medicine and Social Development, Chongqing Medical University
| | - Jiaxiu Liu
- School of Medical Informatics, Chongqing Medical University
| | - Yingjie Ma
- School of Public Health and Management, Research Center for Medicine and Social Development, Chongqing Medical University
| | - Xiaoni Zhong
- School of Public Health and Management, Research Center for Medicine and Social Development, Chongqing Medical University
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Renju J, Seeley J, Moshabela M, Wringe A. Understanding the health systems impacts of Universal Test and Treat in sub-Saharan Africa: The Shape UTT study. Glob Public Health 2020; 16:161-166. [PMID: 33326359 DOI: 10.1080/17441692.2020.1861317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jenny Renju
- London school of Hygiene and Tropical Medicine, UK.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Janet Seeley
- London school of Hygiene and Tropical Medicine, UK.,African Health Research Institute, KwaZulu-Natal, South Africa
| | - Mosa Moshabela
- African Health Research Institute, KwaZulu-Natal, South Africa.,University of KwaZulu-Natal, Durban, South Africa
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