Mudhune Victor, Sharma Monisha, Masyuko Sarah, Ngure Kenneth, Otieno George, Roy Paladhi Unmesha, Katz David A, Kariithi Edward, Farquhar Carey, Bosire Rose
Centre for Global Health Research, Kenya Medical Research Institute, Kisumu P.O. Box 1578-40100, Kenya.
School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi P.O. Box 62000-00200, Kenya.
Healthcare (Basel). 2024 Sep 25;12(19):1918. doi: 10.3390/healthcare12191918.
Assisted partner services (APS) is a recommended public health approach to promote HIV testing for sexual partners of individuals diagnosed with HIV. We evaluated the cost and cost-effectiveness of integrating oral HIV self-testing (HIVST) into existing APS programs. Within the APS-HIVST study conducted in western Kenya (2021-2022), we conducted micro-costing, time-and-motion, and provider surveys to determine incremental HIVST distribution cost (2022 USD). Using a decision tree model, we estimated the incremental cost per new diagnosis (ICND) for HIVST incorporated into APS, compared to APS with provider-delivered testing only. Scenario, parameter and probabilistic sensitivity analyses were conducted to explore influential assumptions. The cost per HIVST distributed within APS was USD 8.97, largest component costs were testing supplies (38%) and personnel (30%). Under conditions of a facility-based testing uptake of <91%, or HIVST utilization rates of <27%, HIVST integration into APS is potentially cost-effective. At a willing-to-pay threshold of USD 1000, the net monetary benefit was sensitive to the effectiveness of HIVST in increasing testing rates, phone call rates, HIVST sensitivity, HIV prevalence, cost of HIVST, space allocation at facilities, and personnel time during facility-based testing. In a best-case scenario, the HIVST option was cheaper by USD 3037 and diagnosed 11 more cases (ICND = 265.82). Implementers and policy makers should ensure that HIVST programs are implemented under conditions that guarantee efficiency by focusing on facilities with low uptake for provider-delivered facility-based testing, while deliberately targeting HIVST utilization among the few likely to benefit from remote testing. Additional measures should focus on minimizing costs relating to personnel and testing supplies.
辅助性伴侣服务（APS）是一种推荐的公共卫生方法，用于促进为被诊断感染艾滋病毒的个体的性伴侣进行艾滋病毒检测。我们评估了将口服艾滋病毒自我检测（HIVST）纳入现有APS项目的成本和成本效益。在肯尼亚西部开展的APS-HIVST研究（2021 - 2022年）中，我们进行了微观成本核算、时间与动作研究以及提供者调查，以确定艾滋病毒自我检测的增量分发成本（2022年美元）。使用决策树模型，我们估计了与仅采用提供者提供检测的APS相比，纳入APS的艾滋病毒自我检测每新增一例诊断的增量成本（ICND）。进行了情景分析、参数分析和概率敏感性分析，以探究有影响的假设。在APS中分发每份艾滋病毒自我检测的成本为8.97美元，最大的成本组成部分是检测用品（38%）和人员（30%）。在基于机构的检测接受率低于91%或艾滋病毒自我检测使用率低于27%的情况下，将艾滋病毒自我检测纳入APS可能具有成本效益。在支付意愿阈值为1000美元时，净货币效益对艾滋病毒自我检测在提高检测率、电话沟通率、艾滋病毒自我检测敏感性、艾滋病毒流行率、艾滋病毒自我检测成本、机构空间分配以及基于机构检测期间的人员时间方面的有效性敏感。在最佳情况下，艾滋病毒自我检测方案成本低3037美元，且多诊断出11例（ICND = 265.82）。实施者和政策制定者应确保艾滋病毒自我检测项目在能保证效率的条件下实施，重点关注基于机构的检测接受率低的机构，同时特意针对少数可能从远程检测中受益的人群提高艾滋病毒自我检测的使用率。其他措施应着重于尽量降低与人员和检测用品相关的成本。
