Traore Métogara Mohamed, Badiane Kéba, Vautier Anthony, Simo Fotso Arlette, Kanku Kabemba Odé, Rouveau Nicolas, Maheu-Giroux Mathieu, Boily Marie-Claude, Larmarange Joseph, Terris-Prestholt Fern, d'Elbée Marc
Solidarité Thérapeutique et Initiative pour la Santé, Abidjan, Côte d'Ivoire.
Solidarité Thérapeutique et Initiative pour la Santé, Dakar, Senegal.
Front Health Serv. 2022 Jun 27;2:886513. doi: 10.3389/frhs.2022.886513. eCollection 2022.
Achieving the first 95 of the UNAIDS targets requires the implementation of innovative approaches to knowing one's HIV status. Among these innovations is the provision of HIV self-testing (HIVST) kits in west Africa by the international partner organization Solthis (IPO). In order to provide guidance for the optimal use of financial resources, this study aims to estimate the program and site level costs of dispensing HIVST as well as HIV testing services (HTS)-excluding HIVST-in health facilities in Côte d'Ivoire, Mali and Senegal as part of the ATLAS project. We estimated from the provider's perspective, HIVST and HTS incremental costs using top-down and bottom-up costing approaches and conducted a time and motion study. We identified costs at the for HIVST (including IPO central costs) and at the for HIVST and HTS. The economic costs of distributing HIVST kits were assessed in 37 health facilities between July 2019 and March 2021 (21 months). Sensitivity analyses were also performed on unit costs to examine the robustness of our estimates related to key assumptions. In total, 16,001 HIVST kits were dispensed for 32,194 HTS sessions carried out. Program level HIVST average costs ranged $12-286, whereas site level costs ranged $4-26 across distribution channels and countries. Site level HTS costs ranged $7-8 per testing session, and ranged $72-705 per HIV diagnosis. Across countries and channels, HIVST costs were driven by personnel (27-68%) and HIVST kits (32-73%) costs. The drivers of HTS costs were personnel costs ranging between 65 and 71% of total costs across distribution channels and countries, followed by supplies costs between 21 and 30%. While program level HIVST average costs were high, site level HIVST average costs remained comparable to HTS costs in all countries. Health facility-based distribution channels operating at low volume exhibit high proportion of central costs which should be considered carefully for financial planning when run alongside high volumes mobile outreach distribution channels. HIVST can diversify the HIV testing offer at health facilities, thus improving access to screening for target populations not reached by HTS services.
要实现联合国艾滋病规划署的首个95%目标，需要采用创新方法来了解个人的艾滋病毒感染状况。这些创新举措之一是国际合作伙伴组织索尔蒂斯（Solthis）在西非提供艾滋病毒自我检测（HIVST）试剂盒。为了为财政资源的最佳使用提供指导，本研究旨在估算作为地图集项目的一部分，在科特迪瓦、马里和塞内加尔的医疗机构中分发HIVST以及艾滋病毒检测服务（HTS，不包括HIVST）的项目和机构层面成本。我们从提供者的角度，使用自上而下和自下而上的成本核算方法估算了HIVST和HTS的增量成本，并进行了时间和动作研究。我们确定了HIVST的成本（包括索尔蒂斯的中央成本）以及HIVST和HTS的成本。在2019年7月至2021年3月（21个月）期间，在37个医疗机构评估了分发HIVST试剂盒的经济成本。还对单位成本进行了敏感性分析，以检验我们与关键假设相关估计的稳健性。总共分发了16,001个HIVST试剂盒，进行了32,194次HTS检测。项目层面的HIVST平均成本在12美元至286美元之间，而机构层面的成本在各分发渠道和国家中为4美元至26美元。机构层面的HTS成本为每次检测7美元至8美元，每次艾滋病毒诊断为72美元至705美元。在不同国家和渠道中，HIVST成本由人员成本（27% - 68%）和HIVST试剂盒成本（32% - 73%）驱动。HTS成本的驱动因素是人员成本，在各分发渠道和国家中占总成本的65%至71%，其次是供应成本，占21%至30%。虽然项目层面的HIVST平均成本较高，但在所有国家中，机构层面的HIVST平均成本与HTS成本相当。低流量运营的基于医疗机构的分发渠道显示出较高比例的中央成本，在与高流量的移动外展分发渠道同时运行时，进行财务规划时应仔细考虑这一点。HIVST可以使医疗机构的艾滋病毒检测方式多样化，从而改善未被HTS服务覆盖的目标人群的筛查机会。
