Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA.
Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
J Int AIDS Soc. 2022 Oct;25(10):e26020. doi: 10.1002/jia2.26020.
Malawi is rapidly closing the gap in achieving the UNAIDS 95-95-95 targets, with 90% of people living with HIV in Malawi aware of their status. As we approach epidemic control, interventions to improve coverage will become more costly. There is, therefore, an urgent need to identify innovative and low-cost strategies to maintain and increase testing coverage without diverting resources from other HIV services. The objective of this study is to model different combinations of facility-based HIV testing modalities and determine the most cost-effective strategy to increase the proportion of men and youth testing for HIV.
A data-driven individual-based model was parameterized with data from a community-representative survey (socio-demographic, health service utilization and HIV testing history) of men and youth in Malawi (data collected August 2019). In total, 79 different strategies for the implementation of HIV self-testing (HIVST) and provider-initiated-testing-and-counselling at the outpatient department (OPD) were evaluated. Outcomes included percent of men/youth tested for HIV in a 12-month period, cost-effectiveness and human resource requirements. The testing yield was assumed to be constant across the scenarios.
Facility-based HIVST offered year-round resulted in the greatest increase in the proportion of men and youth tested in the OPD (from 45% to 72%-83%), was considered cost-saving for HIVST kit priced at $1.00, and generally reduced required personnel as compared to the status quo. At higher HIVST kit prices, and more relaxed eligibility criteria, all scenarios that considered year-round HIVST in the OPD remained on the cost-effectiveness frontier.
Facility-based HIVST is a cost-effective strategy to increase the proportion of men/youth tested for HIV in Malawi and decreases the human resource requirements for HIV testing in the OPD-providing additional healthcare worker time for other priority healthcare activities.
马拉维正在迅速缩小实现艾滋病署 95-95-95 目标的差距，该国 90%的艾滋病毒感染者知晓自身感染状况。随着我们接近流行控制，提高覆盖率的干预措施将变得更加昂贵。因此，迫切需要确定创新和低成本战略，以维持和增加检测覆盖率，同时避免将资源从其他艾滋病毒服务中转移。本研究的目的是模拟基于机构的不同艾滋病毒检测模式组合，并确定最具成本效益的战略，以提高男性和青年艾滋病毒检测比例。
采用数据驱动的个体模型，使用马拉维男性和青年社区代表性调查（社会人口统计学、卫生服务利用和艾滋病毒检测史）的数据进行参数化（数据收集于 2019 年 8 月）。总共评估了 79 种不同的实施艾滋病毒自我检测（HIVST）和门诊部门（OPD）由提供者发起的检测和咨询的策略。结果包括在 12 个月内接受 HIV 检测的男性/青年的百分比、成本效益和人力资源需求。假设检测结果在不同情景下保持不变。
全年提供基于机构的 HIVST 可最大程度地增加 OPD 中男性和青年接受检测的比例（从 45%增加到 72%-83%），对于 1.00 美元的 HIVST 试剂盒而言，被认为是节省成本的，并且通常与现状相比，减少了所需人员。在更高的 HIVST 试剂盒价格和更宽松的资格标准下，所有考虑 OPD 全年提供 HIVST 的情景都保持在成本效益边界内。
基于机构的 HIVST 是增加马拉维男性/青年接受 HIV 检测比例的一种具有成本效益的战略，并减少了 OPD 艾滋病毒检测所需的人力资源，为其他优先医疗保健活动提供了更多的医疗保健工作者时间。
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