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Mujwara D, Kelvin EA, Dahman B, George G, Nixon D, Adera T, Mwai E, Kimmel AD. The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya. Health Policy Plan 2024; 39:355-362. [PMID: 38441272 PMCID: PMC11005835 DOI: 10.1093/heapol/czae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/06/2024] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of offering the choice of self-administered oral HIV-testing (HIVST-Choice) compared with provider-administered testing only [standard-of-care (SOC)] among long-distance truck drivers. Effectiveness data came from a randomized-controlled trial conducted at two roadside wellness clinics in Kenya (HIVST-Choice arm, n = 150; SOC arm, n = 155). Economic cost data came from the literature, reflected a societal perspective and were reported in 2020 international dollars (I$), a hypothetical currency with equivalent purchasing power as the US dollar. Generalized Poisson and linear gamma regression models were used to estimate effectiveness and incremental costs, respectively; incremental effectiveness was reported as the number of long-distance truck drivers needing to receive HIVST-Choice for an additional HIV test-uptake. We calculated the incremental cost-effectiveness ratio (ICER) of HIVST-Choice compared with SOC and estimated 95% confidence intervals (CIs) using non-parametric bootstrapping. Uncertainty was assessed using deterministic sensitivity analysis and the cost-effectiveness acceptability curve. HIV test-uptake was 23% more likely for HIVST-Choice, with six individuals needing to be offered HIVST-Choice for an additional HIV test-uptake. The mean per-patient cost was nearly 4-fold higher in HIVST-Choice (I$39.28) versus SOC (I$10.80), with an ICER of I$174.51, 95% CI [165.72, 194.59] for each additional test-uptake. HIV self-test kit and cell phone service costs were the main drivers of the ICER, although findings were robust even at highest possible costs. The probability of cost-effectiveness approached 1 at a willingness-to-pay of I$200 for each additional HIV test-uptake. HIVST-Choice improves HIV-test-uptake among truck drivers at low willingness-to-pay thresholds, suggesting that HIV self-testing is an efficient use of resources. Policies supporting HIV self-testing in similar high risk, hard-to-reach sub-populations may expedite achievement of international targets.
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Affiliation(s)
- Deo Mujwara
- Department of Health Policy, Virginia Commonwealth University, 830 East Main Street, Richmond, VA 23298, USA
- Analysis Group, Inc, 111 Huntington Ave 4th floor, Boston, MA 02199, USA
| | - Elizabeth A Kelvin
- Department of Epidemiology and Biostatistics & CUNY Institute for Implementation Science in Population Health, City University of New York, 205 East 42nd Street, New York, NY 10017, USA
| | - Bassam Dahman
- Department of Health Policy, Virginia Commonwealth University, 830 East Main Street, Richmond, VA 23298, USA
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa
| | - Daniel Nixon
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University, 1200 E Broad St, Richmond, VA 23219, USA
| | - Tilahun Adera
- Department of Family Medicine and Population Health, Division of Epidemiology, 1200 E. Broad Street, Richmond, VA 23298, USA
| | - Eva Mwai
- North Star Alliance, 8 Silanga Road, Nairobi, Kenya
| | - April D Kimmel
- Department of Health Policy, Virginia Commonwealth University, 830 East Main Street, Richmond, VA 23298, USA
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University, 1200 E Broad St, Richmond, VA 23219, USA
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