Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe.
Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe.
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DOI：
10.1136/bmjgh-2021-005191
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发表时间：
2021-07
影响因子：
8.1
通讯作者：
Terris-Prestholt F
中科院分区：
文献类型：
--
作者：
Sande LA;Matsimela K;Mwenge L;Mangenah C;Choko AT;d'Elbée M;Majam M;Mostert C;Matamwandi I;Sibanda EL;Johnson C;Hatzold K;Ayles H;Cowan FM;Corbett EL;Neuman M;Maheswaran H;Meyer-Rath G;Terris-Prestholt F
随着各国接近联合国艾滋病规划署的95-95-95目标，需要采用创新和节省成本的艾滋病毒检测方法，以增加难以接触到的人群的检测覆盖率。艾滋病毒自检非洲倡议在马拉维、南非、赞比亚和津巴布韦的31个公共设施中使用无奖励的艾滋病毒检测顾问分发艾滋病毒自检包。艾滋病毒/艾滋病传播要么单独通过二级（伴侣使用）传播，要么通过一级（自己使用）和二级传播途径进行。我们从提供者的角度评估了2018年至2019年间在四个国家的31家公共卫生机构中将HIV检测添加到现有HIV检测中的成本。我们结合了支出分析和自下而上的成本计算方法。我们还对咨询人员进行了时间和行动研究，以估计介绍和示范如何将艾滋病毒传播技术用于主要和次要用途所需的人力资源成本。在分析期间共分发了41 720套，从津巴布韦的1254套到赞比亚的27 678套不等。通过初级分发办法分发的每套费用在赞比亚为4.27美元，在津巴布韦为9.24美元。通过二次分发办法分发的每包费用从赞比亚的6.46美元到南非的13.42美元不等，在设施一级的平均费用差别较大。从时间和行动观察来看，咨询人员将20%至44%的工作时间用于艾滋病毒传播。总的来说，人员和测试套件成本是主要的成本驱动因素。在我们的分析中，尽管各国内部的成本差异很大，但分发艾滋病毒传播试剂盒的平均成本在四个国家之间具有可比性。我们建议根据具体情况，从这些设施级别的成本变化和需求创造活动中探索潜在的效率收益，以确保在规模上持续负担得起。
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. 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. 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. 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.
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影响因子：
3.7
作者：
Mayhew SH;Ploubidis GB;Sloggett A;Church K;Obure CD;Birdthistle I;Sweeney S;Warren CE;Watts C;Vassall A;Integra Initiative
通讯作者：
Integra Initiative
影响因子：
3.6
作者：
Sweeney, Sedona;Obure, Carol Dayo;Vassall, Anna
通讯作者：
Vassall, Anna
影响因子：
3.7
作者：
Mwenge L;Sande L;Mangenah C;Ahmed N;Kanema S;d'Elbée M;Sibanda E;Kalua T;Ncube G;Johnson CC;Hatzold K;Cowan FM;Corbett EL;Ayles H;Maheswaran H;Terris-Prestholt F
通讯作者：
Terris-Prestholt F
影响因子：
1.7
作者：
Sande L;Maheswaran H;Mangenah C;Mwenge L;Indravudh P;Mkandawire P;Ahmed N;d’Elbee M;Johnson C;Hatzold K;Corbett EL;Neuman M;Terris-Prestholt F
通讯作者：
Terris-Prestholt F
影响因子：
6
作者：
Hatzold, Karin;Gudukeya, Stephano;Corbett, Elizabeth L.
通讯作者：
Corbett, Elizabeth L.