Cargando…

Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States

INTRODUCTION: HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre‐exposure prophylaxis. Internet distribution of HIV self‐tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs a...

Descripción completa

Detalles Bibliográficos
Autores principales: Shrestha, Ram K, Chavez, Pollyanna R, Noble, Meredith, Sansom, Stephanie L, Sullivan, Patrick S, Mermin, Jonathan H, MacGowan, Robin J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970935/
https://www.ncbi.nlm.nih.gov/pubmed/31960580
http://dx.doi.org/10.1002/jia2.25445
_version_ 1783489611441373184
author Shrestha, Ram K
Chavez, Pollyanna R
Noble, Meredith
Sansom, Stephanie L
Sullivan, Patrick S
Mermin, Jonathan H
MacGowan, Robin J
author_facet Shrestha, Ram K
Chavez, Pollyanna R
Noble, Meredith
Sansom, Stephanie L
Sullivan, Patrick S
Mermin, Jonathan H
MacGowan, Robin J
author_sort Shrestha, Ram K
collection PubMed
description INTRODUCTION: HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre‐exposure prophylaxis. Internet distribution of HIV self‐tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs and cost‐effectiveness of a self‐testing programme. METHODS: Men who have sex with men (MSM) reporting unknown or negative HIV status were enrolled from March to August 2015 into a 12‐month trial of HIV self‐testing in the United States. Participants were randomly assigned either to the self‐testing arm or the control arm. All participants received information on HIV testing services and locations in their community. Self‐testing participants received up to four self‐tests each quarter, which they could use themselves or distribute to their social network associates. Quarterly follow‐up surveys collected testing outcomes, including number of tests used and new HIV diagnoses. Using trial expenditure data, we estimated the cost of implementing a self‐testing programme. Primary outcomes of this analysis included total programme implementation costs, cost per self‐test completed, cost per person tested, cost per new HIV diagnosis among those self‐tested and cost per quality adjusted life year (QALY) saved. RESULTS: A total of 2665 men were assigned either to the self‐testing arm (n = 1325) or the control arm (n = 1340). HIV testing was reported by 971 self‐testing participants who completed a total of 5368 tests. In the control arm, 619 participants completed 1463 HIV tests. The self‐testing participants additionally distributed 2864 self‐tests to 2152 social network associates. Testing during the trial identified 59 participants and social network associates with newly diagnosed HIV infection in the self‐testing arm; 11 control participants were newly diagnosed with HIV. The implementation cost of the HIV self‐testing programme was $449,510. The cost per self‐test completed, cost per person tested at least once, and incremental cost per new HIV diagnosis was $61, $145 and $9365 respectively. We estimated that self‐testing programme potentially averted 3.34 transmissions, saved 14.86 QALYs and nearly $1.6 million lifetime HIV treatment costs. CONCLUSIONS: The HIV self‐testing programme identified persons with newly diagnosed HIV infection at low cost, and the programme is cost saving.
format Online
Article
Text
id pubmed-6970935
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-69709352020-01-27 Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States Shrestha, Ram K Chavez, Pollyanna R Noble, Meredith Sansom, Stephanie L Sullivan, Patrick S Mermin, Jonathan H MacGowan, Robin J J Int AIDS Soc Research Articles INTRODUCTION: HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre‐exposure prophylaxis. Internet distribution of HIV self‐tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs and cost‐effectiveness of a self‐testing programme. METHODS: Men who have sex with men (MSM) reporting unknown or negative HIV status were enrolled from March to August 2015 into a 12‐month trial of HIV self‐testing in the United States. Participants were randomly assigned either to the self‐testing arm or the control arm. All participants received information on HIV testing services and locations in their community. Self‐testing participants received up to four self‐tests each quarter, which they could use themselves or distribute to their social network associates. Quarterly follow‐up surveys collected testing outcomes, including number of tests used and new HIV diagnoses. Using trial expenditure data, we estimated the cost of implementing a self‐testing programme. Primary outcomes of this analysis included total programme implementation costs, cost per self‐test completed, cost per person tested, cost per new HIV diagnosis among those self‐tested and cost per quality adjusted life year (QALY) saved. RESULTS: A total of 2665 men were assigned either to the self‐testing arm (n = 1325) or the control arm (n = 1340). HIV testing was reported by 971 self‐testing participants who completed a total of 5368 tests. In the control arm, 619 participants completed 1463 HIV tests. The self‐testing participants additionally distributed 2864 self‐tests to 2152 social network associates. Testing during the trial identified 59 participants and social network associates with newly diagnosed HIV infection in the self‐testing arm; 11 control participants were newly diagnosed with HIV. The implementation cost of the HIV self‐testing programme was $449,510. The cost per self‐test completed, cost per person tested at least once, and incremental cost per new HIV diagnosis was $61, $145 and $9365 respectively. We estimated that self‐testing programme potentially averted 3.34 transmissions, saved 14.86 QALYs and nearly $1.6 million lifetime HIV treatment costs. CONCLUSIONS: The HIV self‐testing programme identified persons with newly diagnosed HIV infection at low cost, and the programme is cost saving. John Wiley and Sons Inc. 2020-01-20 /pmc/articles/PMC6970935/ /pubmed/31960580 http://dx.doi.org/10.1002/jia2.25445 Text en © 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Articles
Shrestha, Ram K
Chavez, Pollyanna R
Noble, Meredith
Sansom, Stephanie L
Sullivan, Patrick S
Mermin, Jonathan H
MacGowan, Robin J
Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States
title Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States
title_full Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States
title_fullStr Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States
title_full_unstemmed Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States
title_short Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States
title_sort estimating the costs and cost‐effectiveness of hiv self‐testing among men who have sex with men, united states
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970935/
https://www.ncbi.nlm.nih.gov/pubmed/31960580
http://dx.doi.org/10.1002/jia2.25445
work_keys_str_mv AT shrestharamk estimatingthecostsandcosteffectivenessofhivselftestingamongmenwhohavesexwithmenunitedstates
AT chavezpollyannar estimatingthecostsandcosteffectivenessofhivselftestingamongmenwhohavesexwithmenunitedstates
AT noblemeredith estimatingthecostsandcosteffectivenessofhivselftestingamongmenwhohavesexwithmenunitedstates
AT sansomstephaniel estimatingthecostsandcosteffectivenessofhivselftestingamongmenwhohavesexwithmenunitedstates
AT sullivanpatricks estimatingthecostsandcosteffectivenessofhivselftestingamongmenwhohavesexwithmenunitedstates
AT merminjonathanh estimatingthecostsandcosteffectivenessofhivselftestingamongmenwhohavesexwithmenunitedstates
AT macgowanrobinj estimatingthecostsandcosteffectivenessofhivselftestingamongmenwhohavesexwithmenunitedstates