Top

Published in:

Open Access 01-07-2014 | Original Paper

Modelling the Potential Population Impact and Cost-Effectiveness of Self-Testing for HIV: Evaluation of Data Requirements

Authors: Valentina Cambiano, Sue Napierala Mavedzenge, Andrew Phillips

Published in: AIDS and Behavior | Special Issue 4/2014

Abstract

HIV testing uptake has increased dramatically in recent years in resource limited settings. Nevertheless, over 50 % of the people living with HIV are still unaware of their status. HIV self-testing (HIVST) is a potential new approach to facilitate further uptake of testing which requires consideration, taking into account economic factors. Mathematical models and associated economic analysis can provide useful assistance in decision-making processes, offering insight, in this case, into the potential long-term impact at a population level and the price-point at which free or subsidized HIVST would be cost-effective in a given setting. However, models are based on assumptions, and if the required data are sparse or limited, this uncertainty will be reflected in the results from mathematical models. The aim of this paper is to describe the issues encountered in modeling the cost-effectiveness of introducing HIVST, to indicate the evidence needed to support various modeling assumptions, and thus which data on HIVST would be most beneficial to collect.

Sterne JA, May M, Costagliola D, de Wolf F, Phillips AN, Harris R, et al. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. 2009;373(9672):1352–63.PubMedCrossRef

Brinkhof MWG, Boulle A, Weigel R, Messou E, Mathers C, Orrell C, et al. Mortality of HIV-infected patients starting antiretroviral therapy in sub-Saharan Africa: comparison with HIV-unrelated mortality. Plos Med. 2009;6(4):e1000066.PubMedCentralPubMedCrossRef

Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.PubMedCrossRef

Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997. Am J Public Health. 1999;89(9):1397–405.PubMedCentralPubMedCrossRef

Efficacy of voluntary. HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. The Voluntary HIV-1 Counseling and Testing Efficacy Study Group. Lancet. 2000;356(9224):103–12.CrossRef

Fonner VA, Denison J, Kennedy CE, O’Reilly K, Sweat M. Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries. Cochrane Database Syst Rev. 2012;9:CD001224.PubMedCentralPubMed

Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2(11):1112–22.CrossRef

Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369(9562):643–56.PubMedCrossRef

Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657–66.PubMedCrossRef

10.

van der Straten A, Van DL, Haberer JE, Bangsberg DR. Unraveling the divergent results of pre-exposure prophylaxis trials for HIV prevention. AIDS. 2012;26(7):F13–9.PubMedCrossRef

11.

Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.PubMedCentralPubMedCrossRef

12.

Staveteig S, Wang S, Head SK, Bradley SEK, Nybro E. Demographic patterns of HIV testing uptake in Sub-Saharan Africa. DHS comparative report 30. Calverton, Maryland, U.S. 2013.

13.

WHO/UNAIDS. Guidance on provider-initiated HIV testing and counselling in health facilities. 2007.

14.

Report on the first international symposium on self-testing for HIV: The legal, ethical, gender, human rights and public health implications of HIV self-testing scale-up. Geneva, Switzerland. 2013.

15.

MacPherson P, Lalloo D, Choko A, van Oosterhout J, Thindwa D, Webb E, et al. Home assessment and initiation of ART following HIV self-testing: a cluster-randomised trial to improve linkage to ART in Blantyre, Malawi [Abstract]. In: 20th Conference on Retroviruses and Opportunistic Infections. 2013.

16.

Choko AT, Desmond N, Webb EL, Chavula K, Napierala-Mavedzenge S, Gaydos CA, et al. The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi. PLoS Med. 2011;8(10):e1001102.PubMedCentralPubMedCrossRef

17.

Kalibala S, Tun W, Muraah W, Cherutich P, Oweya E, et al. Knowing myself first’: Feasibility of self-testing among health workers in Kenya. Nairobi: Population Council; 2011.

18.

Corbett EL. Uptake, accuracy and linkage into care following access to community-based self-testing for HIV in Malawi. 2013.

19.

Pant PN, Behlim T, Abrahams L, Vadnais C, Shivkumar S, Pillay S, et al. Will an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study. PLoS ONE. 2013;8(11):e79772.CrossRef

20.

Lucas A, Armbruster B. The cost-effectiveness of expanded HIV screening in the United States. AIDS. 2013;27(5):795–801.PubMedCrossRef

21.

Wilson DP, Hoare A, Regan DG, Law MG. Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men. Sex Health. 2009;6(1):19–33.PubMedCrossRef

22.

Sanders GD, Bayoumi AM, Sundaram V, Bilir SP, Neukermans CP, Rydzak CE, et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med. 2005;352(6):570–85.PubMedCrossRef

23.

Paltiel AD, Weinstein MC, Kimmel AD, Seage GR, Losina E, Zhang H, et al. Expanded screening for HIV in the United States—an analysis of cost-effectiveness. N Engl J Med. 2005;352(6):586–95.PubMedCrossRef

24.

Walensky RP, Weinstein MC, Kimmel AD, Seage GR III, Losina E, Sax PE, et al. Routine human immunodeficiency virus testing: an economic evaluation of current guidelines. Am J Med. 2005;118(3):292–300.PubMedCrossRef

25.

Yazdanpanah Y, Sloan CE, Charlois-Ou C, Le Vu S, Semaille C, Costagliola D, et al. Routine HIV screening in France: clinical impact and cost-effectiveness. PLoS One. 2010;5(10):e13132.PubMedCentralPubMedCrossRef

26.

Venkatesh KK, Becker JE, Kumarasamy N, Nakamura YM, Mayer KH, Losina E, et al. Clinical impact and cost-effectiveness of expanded voluntary HIV testing in India. PLoS ONE. 2013;8(5):e64604.PubMedCentralPubMedCrossRef

27.

Walensky RP, Wood R, Fofana MO, Martinson NA, Losina E, April MD, et al. The clinical impact and cost-effectiveness of routine, voluntary HIV screening in South Africa. J Acquir Immune Defic Syndr. 2011;56(1):26–35.PubMedCentralPubMedCrossRef

28.

Waters RC, Ostermann J, Reeves TD, Masnick MF, Thielman NM, Bartlett JA, et al. A cost-effectiveness analysis of alternative HIV retesting strategies in sub-Saharan Africa. Jaids-J Acquir Immune Defic Syndr. 2011;56(5):443–52.CrossRef

29.

Sweat M, Gregorich S, Sangiwa G, Furlonge C, Balmer D, Kamenga C, et al. Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania. Lancet. 2000;356(9224):113–21.PubMedCrossRef

30.

Katz DA, Cassels SL, Stekler JD. Replacing clinic-based tests with home-use tests may increase HIV prevalence among seattle men who have sex with men: evidence from a mathematical model. Sex Transm Dis. 2014;41(1):2–9.PubMedCentralPubMedCrossRef

31.

Bassett IV, Giddy J, Nkera J, Wang B, Losina E, Lu Z, et al. Routine voluntary HIV testing in Durban, South Africa—the experience from an outpatient department. Jaids-J Acquir Immune Defic Syndr. 2007;46(2):181–6.CrossRef

32.

Carballo-Dieguez A, Frasca T, Dolezal C, Balan I. Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? J Sex Res. 2012;49(4):379–87.PubMedCentralPubMedCrossRef

33.

Lee VJ, Tan SC, Earnest A, Seong PS, Tan HH, Leo YS. User acceptability and feasibility of self-testing with HIV rapid tests. J Acquir Immune Defic Syndr. 2007;45(4):449–53.PubMedCrossRef

34.

Ng OT, Chow AL, Lee VJ, Chen MI, Win MK, Tan HH, et al. Accuracy and user-acceptability of HIV self-testing using an oral fluid-based HIV rapid test. PLoS ONE. 2012;7(9):e45168.PubMedCentralPubMedCrossRef

35.

van Dyk AC. Client-initiated, provider-initiated, or self-testing for HIV: what do South Africans prefer? J Assoc Nurses AIDS Care. 2013;24(6):e45–56.PubMedCrossRef

36.

Bilardi JE, Walker S, Read T, Prestage G, Chen MY, Guy R, et al. Gay and bisexual men’s views on rapid self-testing for HIV. AIDS Behav. 2013;17(6):2093–9.PubMedCrossRef

37.

Greacen T, Friboulet D, Blachier A, Fugon L, Hefez S, Lorente N, et al. Internet-using men who have sex with men would be interested in accessing authorised HIV self-tests available for purchase online. AIDS Care. 2013;25(1):49–54.PubMedCrossRef

38.

Carballo-Dieguez A, Frasca T, Balan I, Ibitoye M, Dolezal C. Use of a rapid HIV home test prevents HIV exposure in a high risk sample of men who have sex with men. AIDS Behav. 2012;16(7):1753–60.PubMedCentralPubMedCrossRef

39.

Choko AT, MacPherson P, Webb EL, Ball H, Sambakunsi R, Mdolo A, et al. One year outcomes following community-based HIV self-testing: a prospective study in Malawi. In: Conference on Retroviruses and Opportunistic Infections. 2014.

40.

Pant PN, Bhargava M, Joseph L, Sharma J, Pillay S, Balram B, et al. Will an unsupervised self-testing strategy be feasible to operationalize in Canada? Results from a pilot study in students of a large Canadian university. AIDS Res Treat. 2014;2014:747619.

41.

Suthar AB, Ford N, Bachanas PJ, Wong VJ, Rajan JS, Saltzman AK, et al. Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS Med. 2013;10(8):e1001496.PubMedCentralPubMedCrossRef

42.

Bavinton BR, Brown G, Hurley M, Bradley J, Keen P, Conway DP, et al. Which gay men would increase their frequency of HIV testing with home self-testing? AIDS Behav. 2013;17(6):2084–92.PubMedCrossRef

43.

Hoyos J, Belza MJ, Fernandez-Balbuena S, Rosales-Statkus ME, Pulido J, de la Fuente L. Preferred HIV testing services and programme characteristics among clients of a rapid HIV testing programme. BMC Public Health. 2013;13(1):791.PubMedCentralPubMedCrossRef

44.

Spielberg F, Camp S, Ramachandra E. HIV home self-testing: can it work? [Abstract]. In: National HIV Prevention Conference; 2003.

45.

Gaydos CA, Solis M, Hsieh YH, Jett-Goheen M, Nour S, Rothman RE. Use of tablet-based kiosks in the emergency department to guide patient HIV self-testing with a point-of-care oral fluid test. Int J STD AIDS. 2013;24(9):716–21.PubMedCentralPubMedCrossRef

46.

Spielberg F, Bill and Melinda Gates Foundation. Acceptability of self-testing for STIs in India. 2010.

47.

Wright AA, Katz IT. Home testing for HIV. N Engl J Med. 2006;354(5):437–40.PubMedCrossRef

48.

Pant PN, Balram B, Shivkumar S, Martinez-Cajas JL, Claessens C, Lambert G, et al. Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(5):373–80.CrossRef

49.

U.S.Food and Drug administration. First rapid home-use HIV kit approved for self-testing. 2012.

50.

Gaydos CA, Hsieh YH, Harvey L, Burah A, Won H, Jett-Goheen M, et al. Will patients “opt in” to perform their own rapid HIV test in the emergency department? Ann Emerg Med. 2011;58(1 Suppl 1):S74–8.PubMedCentralPubMedCrossRef

51.

Asiimwe S, Oloya J, Song X, Whalen CC. Accuracy of un-supervised versus provider-supervised self-administered HIV testing in Uganda: a randomized implementation trial. AIDS Behav. 2014.

52.

Napierala MS, Baggaley R, Corbett EL. A review of self-testing for HIV: research and policy priorities in a new era of HIV prevention. Clin Infect Dis. 2013;57(1):126–38.CrossRef

53.

Kennedy CE, Fonner VA, Sweat MD, Okero FA, Baggaley R, O’Reilly KR. Provider-initiated HIV testing and counseling in low- and middle-income countries: a systematic review. AIDS Behav. 2012;17(5):1571–90.CrossRef

54.

Ng OT, Tan MT. HIV self-testing: money matters. Clin Infect Dis. 2013;57(5):771–2.PubMedCrossRef

55.

Katz DA, Golden MR, Hughes JP, Farquhar C, Stekler JD. Acceptability and ease of use of home self-testing for HIV among MSM [Abstract]. In: 19th Conference on Retroviruses and Opportunistic Infections. 2012.

56.

Joint United Nations Programme on HIV AIDS eSFUNCF & WHiG. Sources and prices of selected medicines and diagnostics for people living with HIV/AIDS/a joint UNICEF, UNAIDS, WHO, MSF project. - 6th ed. 2005.

57.

Phillips AN, Pillay D, Garnett G, Bennett D, Vitoria M, Cambiano V, et al. Effect on transmission of HIV-1 resistance of timing of implementation of viral load monitoring to determine switches from first to second-line antiretroviral regimens in resource-limited settings. AIDS. 2011;25(6):843–50.PubMedCrossRef

58.

Cambiano V, Bertagnolio S, Jordan MR, Lundgren JD, Phillips A. Transmission of drug resistant HIV and its potential impact on mortality and treatment outcomes in resource-limited settings. J Infect Dis. 2013;207(Suppl 2):S57–62.PubMedCrossRef

59.

Ingole NA, Mehta PR, Bande RN, Paranjpe SM, Wanjare SW. Evaluation of Calypte AWARE HIV-1/2 OMT antibody test as a screening test in an Indian setting. Indian J Med Microbiol. 2010;28(4):295–8.PubMedCrossRef

60.

Mayhood MK, Afwamba IA, Odhiambo CO, Ndanu E, Thielman NM, Morrissey AB, et al. Validation, performance under field conditions, and cost-effectiveness of Capillus HIV-1/HIV-2 and determine HIV-1/2 rapid human immunodeficiency virus antibody assays using sequential and parallel testing algorithms in Tanzania. J Clin Microbiol. 2008;46(12):3946–51.PubMedCentralPubMedCrossRef

61.

Alemnji GA, Ngulefac GA, Ndumbe PM, Asonganyi T. Field evaluation of Calypte’s AWARE blood serum plasma (BSP) and oral mucosal transudate (OMT) rapid tests for detecting antibodies to HIV-1 and 2 in plasma and oral fluid. Open AIDS J. 2009;3:14–8.PubMedCentralPubMedCrossRef

62.

de la Fuente L, Rosales-Statkus ME, Hoyos J, Pulido J, Santos S, Bravo MJ, et al. Are participants in a street-based HIV testing program able to perform their own rapid test and interpret the results? PLoS ONE. 2012;7(10):e46555.PubMedCentralPubMedCrossRef

Title: Modelling the Potential Population Impact and Cost-Effectiveness of Self-Testing for HIV: Evaluation of Data Requirements
Authors: Valentina Cambiano
Sue Napierala Mavedzenge
Andrew Phillips
Publication date: 01-07-2014
Publisher: Springer US
Published in: AIDS and Behavior / Issue Special Issue 4/2014
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-014-0824-x

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Modelling the Potential Population Impact and Cost-Effectiveness of Self-Testing for HIV: Evaluation of Data Requirements

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 4/2014

What Should the Ideal HIV Self-Test Look Like? A Usability Study of Test Prototypes in Unsupervised HIV Self-Testing in Kenya, Malawi, and South Africa

Realizing the Potential for HIV Self-Testing

HIV Self-Testing in Resource-Limited Settings: Regulatory and Policy Considerations

A Review of the Evidence of Harm from Self-Tests

The Ethical, Legal and Human Rights Concerns Raised by Licensing HIV Self-Testing for Private Use

Factors Associated with Acceptability of HIV Self-Testing Among Health Care Workers in Kenya

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page