Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe

Linda Alinafe Sande; Katleho Matsimela; Lawrence Mwenge; Collin Mangenah; Augustine Choko; Marc D'Elbée; Mohammed Majam; Cyprian Mostert; Inonge Matamwandi; Euphemia Sibanda; Cheryl Johnson; Karin Hatzold; Helen Ayles; Frances Cowan; Elizabeth Lucy Corbett; Melissa Neuman; Hendramoorthy Maheswaran; Gesine Meyer-Rath; Fern Terris-Prestholt

doi:10.1136/bmjgh-2021-005191

Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe

Linda Alinafe Sande, Katleho Matsimela, Lawrence Mwenge, Collin Mangenah, Augustine Choko, Marc D'Elbée, Mohammed Majam, Cyprian Mostert, Inonge Matamwandi, Euphemia Sibanda, Cheryl Johnson, Karin Hatzold, Helen Ayles, Frances Cowan, Elizabeth Lucy Corbett, Melissa Neuman, Hendramoorthy Maheswaran, Gesine Meyer-Rath, Fern Terris-Prestholt

International Public Health

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

Abstract

Introduction

As countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner’s use) distribution alone or primary (own use) and secondary distribution approaches.

Methods

We evaluated the costs of adding HIVST to existing HIV testing from the providers’ perspective in the 31 public health facilities across the four countries between 2018 and 2019. We combined expenditure analysis and bottom-up costing approaches. We also carried out time-and-motion studies on the counsellors to estimate the human resource costs of introducing and demonstrating how to use HIVST for primary and secondary use.

Results

A total of 41 720 kits were distributed during the analysis period, ranging from 1254 in Zimbabwe to 27 678 in Zambia. The cost per kit distributed through the primary distribution approach was $4.27 in Zambia and $9.24 in Zimbabwe. The cost per kit distributed through the secondary distribution approach ranged from $6.46 in Zambia to $13.42 in South Africa, with a wider variation in the average cost at facility-level. From the time-and-motion observations, the counsellors spent between 20% and 44% of the observed workday on HIVST. Overall, personnel and test kit costs were the main cost drivers.

Conclusion

The average costs of distributing HIVST kits were comparable across the four countries in our analysis despite wide cost variability within countries. We recommend context-specific exploration of potential efficiency gains from these facility-level cost variations and demand creation activities to ensure continued affordability at scale.

Original language	English
Article number	e005191
Pages (from-to)	e005191
Journal	BMJ Global Health
Volume	6
DOIs	https://doi.org/10.1136/bmjgh-2021-005191
Publication status	Published - 18 Jul 2021

Keywords

AIDS
diagnostics and tools
health economics
HIV
public health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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E005191Final published version, 501 KBLicence: CC BY-NC

Cite this

Sande, L. A., Matsimela, K., Mwenge, L., Mangenah, C., Choko, A., D'Elbée, M., Majam, M., Mostert, C., Matamwandi, I., Sibanda, E., Johnson, C., Hatzold, K., Ayles, H., Cowan, F., Corbett, E. L., Neuman, M., Maheswaran, H., Meyer-Rath, G., & Terris-Prestholt, F. (2021). Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe. BMJ Global Health, 6, e005191. Article e005191. https://doi.org/10.1136/bmjgh-2021-005191

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title = "Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe",

abstract = "IntroductionAs countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner{\textquoteright}s use) distribution alone or primary (own use) and secondary distribution approaches.MethodsWe evaluated the costs of adding HIVST to existing HIV testing from the providers{\textquoteright} perspective in the 31 public health facilities across the four countries between 2018 and 2019. We combined expenditure analysis and bottom-up costing approaches. We also carried out time-and-motion studies on the counsellors to estimate the human resource costs of introducing and demonstrating how to use HIVST for primary and secondary use.ResultsA total of 41 720 kits were distributed during the analysis period, ranging from 1254 in Zimbabwe to 27 678 in Zambia. The cost per kit distributed through the primary distribution approach was \$4.27 in Zambia and \$9.24 in Zimbabwe. The cost per kit distributed through the secondary distribution approach ranged from \$6.46 in Zambia to \$13.42 in South Africa, with a wider variation in the average cost at facility-level. From the time-and-motion observations, the counsellors spent between 20\% and 44\% of the observed workday on HIVST. Overall, personnel and test kit costs were the main cost drivers.ConclusionThe average costs of distributing HIVST kits were comparable across the four countries in our analysis despite wide cost variability within countries. We recommend context-specific exploration of potential efficiency gains from these facility-level cost variations and demand creation activities to ensure continued affordability at scale.",

keywords = "AIDS, diagnostics and tools, health economics, HIV, public health",

author = "Sande, \{Linda Alinafe\} and Katleho Matsimela and Lawrence Mwenge and Collin Mangenah and Augustine Choko and Marc D'Elb{\'e}e and Mohammed Majam and Cyprian Mostert and Inonge Matamwandi and Euphemia Sibanda and Cheryl Johnson and Karin Hatzold and Helen Ayles and Frances Cowan and Corbett, \{Elizabeth Lucy\} and Melissa Neuman and Hendramoorthy Maheswaran and Gesine Meyer-Rath and Fern Terris-Prestholt",

year = "2021",

month = jul,

day = "18",

doi = "10.1136/bmjgh-2021-005191",

language = "English",

volume = "6",

pages = "e005191",

journal = "BMJ Global Health",

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Sande, LA, Matsimela, K, Mwenge, L, Mangenah, C , Choko, A, D'Elbée, M, Majam, M, Mostert, C, Matamwandi, I, Sibanda, E, Johnson, C, Hatzold, K, Ayles, H, Cowan, F, Corbett, EL, Neuman, M, Maheswaran, H, Meyer-Rath, G & Terris-Prestholt, F 2021, 'Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe', BMJ Global Health, vol. 6, e005191, pp. e005191. https://doi.org/10.1136/bmjgh-2021-005191

TY - JOUR

T1 - Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe

AU - Sande, Linda Alinafe

AU - Matsimela, Katleho

AU - Mwenge, Lawrence

AU - Mangenah, Collin

AU - Choko, Augustine

AU - D'Elbée, Marc

AU - Majam, Mohammed

AU - Mostert, Cyprian

AU - Matamwandi, Inonge

AU - Sibanda, Euphemia

AU - Johnson, Cheryl

AU - Hatzold, Karin

AU - Ayles, Helen

AU - Cowan, Frances

AU - Corbett, Elizabeth Lucy

AU - Neuman, Melissa

AU - Maheswaran, Hendramoorthy

AU - Meyer-Rath, Gesine

AU - Terris-Prestholt, Fern

PY - 2021/7/18

Y1 - 2021/7/18

N2 - IntroductionAs countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner’s use) distribution alone or primary (own use) and secondary distribution approaches.MethodsWe evaluated the costs of adding HIVST to existing HIV testing from the providers’ perspective in the 31 public health facilities across the four countries between 2018 and 2019. We combined expenditure analysis and bottom-up costing approaches. We also carried out time-and-motion studies on the counsellors to estimate the human resource costs of introducing and demonstrating how to use HIVST for primary and secondary use.ResultsA total of 41 720 kits were distributed during the analysis period, ranging from 1254 in Zimbabwe to 27 678 in Zambia. The cost per kit distributed through the primary distribution approach was $4.27 in Zambia and $9.24 in Zimbabwe. The cost per kit distributed through the secondary distribution approach ranged from $6.46 in Zambia to $13.42 in South Africa, with a wider variation in the average cost at facility-level. From the time-and-motion observations, the counsellors spent between 20% and 44% of the observed workday on HIVST. Overall, personnel and test kit costs were the main cost drivers.ConclusionThe average costs of distributing HIVST kits were comparable across the four countries in our analysis despite wide cost variability within countries. We recommend context-specific exploration of potential efficiency gains from these facility-level cost variations and demand creation activities to ensure continued affordability at scale.

AB - IntroductionAs countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner’s use) distribution alone or primary (own use) and secondary distribution approaches.MethodsWe evaluated the costs of adding HIVST to existing HIV testing from the providers’ perspective in the 31 public health facilities across the four countries between 2018 and 2019. We combined expenditure analysis and bottom-up costing approaches. We also carried out time-and-motion studies on the counsellors to estimate the human resource costs of introducing and demonstrating how to use HIVST for primary and secondary use.ResultsA total of 41 720 kits were distributed during the analysis period, ranging from 1254 in Zimbabwe to 27 678 in Zambia. The cost per kit distributed through the primary distribution approach was $4.27 in Zambia and $9.24 in Zimbabwe. The cost per kit distributed through the secondary distribution approach ranged from $6.46 in Zambia to $13.42 in South Africa, with a wider variation in the average cost at facility-level. From the time-and-motion observations, the counsellors spent between 20% and 44% of the observed workday on HIVST. Overall, personnel and test kit costs were the main cost drivers.ConclusionThe average costs of distributing HIVST kits were comparable across the four countries in our analysis despite wide cost variability within countries. We recommend context-specific exploration of potential efficiency gains from these facility-level cost variations and demand creation activities to ensure continued affordability at scale.

KW - AIDS

KW - diagnostics and tools

KW - health economics

KW - HIV

KW - public health

U2 - 10.1136/bmjgh-2021-005191

DO - 10.1136/bmjgh-2021-005191

M3 - Article

VL - 6

SP - e005191

JO - BMJ Global Health

JF - BMJ Global Health

M1 - e005191

ER -

Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe

Abstract

Keywords

UN SDGs

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