AUTHOR=Amstutz Alain , Matsela Lineo , Lejone Thabo Ishmael , Kopo Mathebe , Glass Tracy Renée , Labhardt Niklaus Daniel 

TITLE=Reaching Absent and Refusing Individuals During Home-Based HIV Testing Through Self-Testing—at What Cost?

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.653677

DOI=10.3389/fmed.2021.653677

ISSN=2296-858X

ABSTRACT=<p><bold>Introduction:</bold> In the HOSENG trial (NCT03598686), the secondary distribution of oral self-tests for persons absent or refusing to test during a home-based HIV testing campaign in rural Lesotho resulted in an increase in testing coverage of 21% compared to a testing campaign without secondary distribution. This study aims to determine the per patient costs of both HOSENG trial arms.</p><p><bold>Method:</bold> We conducted a micro-costing study to estimate the cost of home-based HIV testing with (HOSENG intervention arm) and without (HOSENG control arm) secondary self-test distribution from a provider's perspective. A mixture of top-down and bottom-up costing was used. We estimated both the financial and economic per patient costs of each possible testing cascade scenario. The costs were adjusted to 2018 US$.</p><p><bold>Results:</bold> The overall provider cost for delivering the home-based HIV testing with secondary distribution was US$36,481 among the 4,174 persons enumerated and 3,094 eligible for testing in the intervention villages compared to US$28,620 for 3,642 persons enumerated and 2,727 eligible for testing in the control. The cost per person eligible for testing was US$11.79 in the intervention vs. US$10.50 in the control. This difference was mainly driven by the cost of distributed oral self-tests. The cost per person tested was, however, lower in intervention villages (US$15.70 vs. US$22.15) due to the higher testing coverage achieved through self-test distribution. The cost per person confirmed new HIV+ was US$889.79 in the intervention and US$753.17 in the control.</p><p><bold>Conclusion:</bold> During home-based HIV testing in Lesotho, the secondary distribution of self-tests for persons absent or refusing to test during the visit reduced the costs per person tested and thus presents a promising add-on for such campaigns.</p><p><bold>Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="https://ClinicalTrials.gov/" xmlns:xlink="http://www.w3.org/1999/xlink">https://ClinicalTrials.gov/</ext-link>, identifier: NCT03598686</p>