Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
BMJ Glob Health. 2021 Jul;6(Suppl 4). doi: 10.1136/bmjgh-2020-004593.
INTRODUCTION: Community-based strategies can extend coverage of HIV testing and diagnose HIV at earlier stages of infection but can be costly to implement. We evaluated the costs and effects of community-led delivery of HIV self-testing (HIVST) in Mangochi District, Malawi. METHODS: This economic evaluation was based within a pragmatic cluster-randomised trial of 30 group village heads and their catchment areas comparing the community-led HIVST intervention in addition to the standard of care (SOC) versus the SOC alone. The intervention involved mobilising community health groups to lead 7-day HIVST campaigns including distribution of HIVST kits. The SOC included facility-based HIV testing services. Primary costings estimated economic costs of the intervention and SOC from the provider perspective, with costs annualised and measured in 2018 US$. A postintervention survey captured individual-level data on HIV testing events, which were combined with unit costs from primary costings, and outcomes. The incremental cost per person tested HIV-positive and associated uncertainty were estimated. RESULTS: Overall, the community-led HIVST intervention costed $138 624 or $5.70 per HIVST kit distributed, with test kits and personnel the main contributing costs. The SOC costed $263 400 or $4.57 per person tested. Individual-level provider costs were higher in the community-led HIVST arm than the SOC arm (adjusted mean difference $3.77, 95% CI $2.44 to $5.10; p<0.001), while the intervention effect on HIV positivity varied based on adjustment for previous diagnosis. The incremental cost per person tested HIV positive was $324 but increased to $1312 and $985 when adjusting for previously diagnosed self-testers or self-testers on treatment, respectively. Community-led HIVST demonstrated low probability of being cost-effective against plausible willingness-to-pay values, with HIV positivity a key determinant. CONCLUSION: Community-led HIVST can provide HIV testing at a low additional unit cost. However, adding community-led HIVST to the SOC was not likely to be cost-effective, especially in contexts with low prevalence of undiagnosed HIV. TRIAL REGISTRATION NUMBER: NCT03541382.
介绍：基于社区的策略可以扩大艾滋病毒检测的覆盖面，并在感染的早期阶段诊断艾滋病毒，但实施起来成本很高。我们评估了在马拉维曼戈乔地区由社区主导的艾滋病毒自我检测（HIVST）的成本和效果。
方法：这是一项基于实用的群组随机试验的经济评估，该试验比较了 30 个村庄小组组长及其集水区，比较了社区主导的 HIVST 干预措施，以及标准护理（SOC）与 SOC 单独使用。该干预措施包括动员社区卫生团体开展为期 7 天的 HIVST 运动，包括分发 HIVST 试剂盒。SOC 包括基于设施的艾滋病毒检测服务。主要成本从提供者的角度估算了干预措施和 SOC 的经济成本，成本按年度计算，并以 2018 年美元为单位进行衡量。干预后调查收集了个人层面的艾滋病毒检测事件数据，这些数据与初级成本核算中的单位成本以及结果相结合。估计了每检测出一名艾滋病毒阳性者的增量成本及其不确定性。
结果：总体而言，社区主导的 HIVST 干预成本为 138624 美元，或每分发一个 HIVST 试剂盒 5.70 美元，试剂盒和人员是主要的成本贡献者。SOC 的成本为 263400 美元，或每人检测费用为 4.57 美元。与 SOC 相比，社区主导的 HIVST 臂的个人层面提供者成本更高（调整后的平均差异为 3.77，95%置信区间为 2.44 至 5.10；p<0.001），而干预对 HIV 阳性的影响因对先前诊断的调整而异。每检测出一名艾滋病毒阳性者的增量成本为 324 美元，但当分别调整为先前诊断的自我检测者或正在接受治疗的自我检测者时，该成本增加至 1312 美元和 985 美元。社区主导的 HIVST 在低艾滋病毒未确诊率的情况下，对合理的支付意愿值来说，其具有低概率的成本效益，而 HIV 阳性是一个关键决定因素。
结论：社区主导的 HIVST 可以以较低的单位成本提供艾滋病毒检测。然而，在 SOC 中增加社区主导的 HIVST 不太可能具有成本效益，尤其是在艾滋病毒未确诊率较低的情况下。
试验注册：NCT03541382。
BMJ Glob Health. 2021-7
Healthcare (Basel). 2024-9-25
Bull World Health Organ. 2019-11-1
Zotero 插件
