Centre for Sexual Health, HIV and AIDS Research, Harare, Zimbabwe.
Zambart, Lusaka, Zambia.
J Int AIDS Soc. 2019 Mar;22 Suppl 1(Suppl Suppl 1):e25255. doi: 10.1002/jia2.25255.
INTRODUCTION: HIV self-testing (HIVST) is recommended by the World Health Organization in addition to other testing modalities to increase uptake of HIV testing, particularly among harder-to-reach populations. This study provides the first empirical evidence of the costs of door-to-door community-based HIVST distribution in Malawi, Zambia and Zimbabwe. METHODS: HIVST kits were distributed door-to-door in 71 sites across Malawi, Zambia and Zimbabwe from June 2016 to May 2017. Programme expenditures, supplemented by on-site observation and monitoring and evaluation data were used to estimate total economic and unit costs of HIVST distribution, by input and site. Inputs were categorized into start-up, capital and recurrent costs. Sensitivity and scenario analyses were performed to assess the impact of key parameters on unit costs. RESULTS: In total, 152,671, 103,589 and 93,459 HIVST kits were distributed in Malawi, Zambia and Zimbabwe over 12, 11 and 10 months respectively. Across these countries, 43% to 51% of HIVST kits were distributed to men. The average cost per HIVST kit distributed was US$8.15, US$16.42 and US$13.84 in Malawi, Zambia and Zimbabwe, respectively, with pronounced intersite variation within countries driven largely by site-level fixed costs. Site-level recurrent costs were 70% to 92% of full costs and 20% to 62% higher than routine HIV testing services (HTS) costs. Personnel costs contributed from 26% to 52% of total costs across countries reflecting differences in remuneration approaches and country GDP. CONCLUSIONS: These early door-to-door community HIVST distribution programmes show large potential, both for reaching untested populations and for substantial economies of scale as HIVST programmes scale-up and mature. From a societal perspective, the costs of HIVST appear similar to conventional HTS, with the higher providers' costs substantially offsetting user costs. Future approaches to minimizing cost and/or maximize testing coverage could include unpaid door-to-door community-led distribution to reach end-users and integrating HIVST into routine clinical services via direct or secondary distribution strategies with lower fixed costs.
简介：世界卫生组织建议将 HIV 自我检测（HIVST）与其他检测方式相结合，以增加 HIV 检测的普及率，尤其是在更难接触到的人群中。本研究提供了在马拉维、赞比亚和津巴布韦首次进行基于社区的上门 HIVST 分发成本的实证证据。
方法：2016 年 6 月至 2017 年 5 月，HIVST 试剂盒在马拉维、赞比亚和津巴布韦的 71 个地点进行了上门分发。根据投入和地点，利用方案支出以及现场观察、监测和评估数据，估算了 HIVST 分发的总经济成本和单位成本。投入分为启动、资本和经常性成本。进行了敏感性和情景分析，以评估关键参数对单位成本的影响。
结果：在马拉维、赞比亚和津巴布韦，12、11 和 10 个月分别分发了 152671、103589 和 93459 份 HIVST 试剂盒。在这些国家中，43%至 51%的 HIVST 试剂盒分发给了男性。每份 HIVST 试剂盒的平均分发成本分别为 8.15 美元、16.42 美元和 13.84 美元，各国之间的站点间差异很大，主要原因是站点级别的固定成本。站点级别的经常性成本占总成本的 70%至 92%，比常规 HIV 检测服务（HTS）成本高 20%至 62%。人员成本占各国总成本的 26%至 52%，反映了薪酬方法和国家 GDP 的差异。
结论：这些早期的上门社区 HIVST 分发方案显示出巨大的潜力，既能接触到未接受检测的人群，又能在 HIVST 项目扩大规模和成熟时实现大规模经济。从社会角度来看，HIVST 的成本似乎与传统 HTS 相似，较高的提供者成本大大抵消了用户成本。未来可以通过非付费上门社区主导的分发方式来接触最终用户，以及通过固定成本较低的直接或二级分发策略将 HIVST 整合到常规临床服务中，以降低成本和/或最大限度地提高检测覆盖率。
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