The costs of home-based HIV testing and counselling in sub-Saharan Africa and its association with testing yield: a literature review
File(s)
Accepted version
Author(s)
Hauck, Katharina
Type
Journal Article
Abstract
More than 14.5 of the 36.7 million people living with HIV globally do not know their HIV status, making comprehensive testing interventions a critical step in ending the HIV/AIDS epidemic. Home-based testing and counselling (HBTC) involves small teams of community health workers with basic training going from door-to-door and offering services in people's homes. HBTC is effective in reaching individuals that are unlikely to test otherwise, but there is conflicting evidence on its costs and little insight into why estimates are different. We undertook a comparative review of existing costing studies of HBTC in sub-Saharan Africa. Yield or positivity rate, the number of persons tested positive among all tested, is an important metric to judge the efficacy of a testing campaign. We conducted descriptive analyses to test whether unit costs are associated with yield. Studies varied in size with a maximum of 264 953 and a minimum of 494 persons tested. The average "cost per person tested" across 14 studies was $22.8 (SD $14.5) with a minimum of $6 and a maximum of $55.4, and the average "cost per person tested HIV-positive' across 12 studies was $439.4 (SD $399.7) with a minimum of $66.2 and a maximum of $800.9. Correlations between unit cost estimates and yield were not statistically significant. Existant estimates of the costs of HBTC are conflicting, and it is likely that differences in the setting, design and implementation of the studies are responsible for the discrepancies. This makes it difficult to reliably estimate the costs and cost-effectiveness of HBTC.
Date Issued
2019-12-01
Date Acceptance
2019-11-01
Citation
African Journal of AIDS Research, 2019, 18 (4), pp.324-331
ISSN
1608-5906
Publisher
National Inquiry Services Centre
Start Page
324
End Page
331
Journal / Book Title
African Journal of AIDS Research
Volume
18
Issue
4
Copyright Statement
© 2019 NISC (Pty) Ltd. Co-published by NISC (Pty) Ltd and Informa UK Limited (trading as Taylor & Francis Group). This is an Accepted Manuscript of an article published by Taylor & Francis in African Journal of AIDS Research on 28 Nov 2019, available online: https://www.tandfonline.com/doi/abs/10.2989/16085906.2019.1680399
Sponsor
National Institute for Health Research
Medical Research Council (MRC)
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31779570
Grant Number
HPRU-2012-10080
MR/R015600/1
Subjects
HBTC
home-based testing and counselling
price
unit cost analysis
Publication Status
Published
Coverage Spatial
South Africa
Date Publish Online
2019-11-28