ArticleJournal of the International AIDS Society2019
The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis.
Article in Journal of the International AIDS Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 67 papers, 5 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
67 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses.PharmacoEconomics · 2024Pooled it
- Evidence Gaps in Economic Evaluations of HIV Interventions Targeting Young People: A Systematic Review.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2024Pooled it
- Modelling Methods of Economic Evaluations of HIV Testing Strategies in Sub-Saharan Africa: A Systematic Review.Applied health economics and health policy · 2023Pooled it
- How much does HIV self-testing cost in low and middle income countries? A systematic review of evidence from economic studies.Frontiers in public health · 2023Pooled it
- HIV Self-Testing Uptake and Intervention Strategies Among Men in Sub-Saharan Africa: A Systematic Review.Frontiers in public health · 2021Pooled it
- AEGIDA: Results of a Pilot Randomized Trial of an HIV Self-Testing Intervention for Women Who Exchange Sex and Use Substances in Kazakhstan.AIDS and behavior · 2026Trial
- The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya.Health policy and planning · 2024Trial
- Expanding syphilis test uptake using rapid dual self-testing for syphilis and HIV among men who have sex with men in China: A multiarm randomized controlled trial.PLoS medicine · 2022Trial
- Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial.The Lancet. Global health · 2021Trial
- Effect of door-to-door distribution of HIV self-testing kits on HIV testing and antiretroviral therapy initiation: a cluster randomised trial in Malawi.BMJ global health · 2021Trial
- Effect of community-led delivery of HIV self-testing on HIV testing and antiretroviral therapy initiation in Malawi: A cluster-randomised trial.PLoS medicine · 2021Trial
- Cost-Effectiveness of the I'm Ready HIV Self-Testing Programme Among High-Risk Populations in Canada.Journal of the International AIDS Society · 2026Article
- Epidemiological yield and cost-effectiveness of non-targeted community HIV screening in a low-prevalence district: a prospective quasi-experimental study.Frontiers in public health · 2026Article
- Optimizing the location of point-of-care infant HIV testing devices in Zimbabwe to maximize impact and value: A modeling analysis.PloS one · 2026Article
- Article
- Cost-effectiveness analysis in primary care research: A practical guide for early-career researchers.African journal of primary health care & family medicine · 2025Article
- Temporal Trends and Characteristics of Community-Based HIV Testing: First Community-Based Testing Program Results of Men Who Had Sex with Men and Female Sex Workers in Haiti, 2015-2018.The American journal of tropical medicine and hygiene · 2025Article
- Cost-Effectiveness Analyses of Adolescent- and Young-Adult-Focused HIV Interventions Incorporating HIV Transmission: a Scoping Review of Modeling Methods and Proposed Guidance.PharmacoEconomics - open · 2025Review
- Developing and Validating an Inclusive and Cost-Effective Prediction Algorithm for Survival and Death Among People Living With HIV in Sub-Saharan Africa: Protocol for a Meta-Analysis and Case-Control and Cost-Effectiveness Study.JMIR research protocols · 2025Article
- Strategies and challenges for maintaining the continuity of essential health services during a pandemic: a scoping review.BMC health services research · 2025Article
7 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
15 authors.
Funding
Abstract
introductionThe prevalence of undiagnosed HIV is declining in Africa, and various HIV testing approaches are finding lower positivity rates. In this context, the epidemiological impact and cost-effectiveness of community-based HIV self-testing (CB-HIVST) is unclear. We aimed to assess this in different sub-populations and across scenarios characterized by different adult HIV prevalence and antiretroviral treatment programmes in sub-Saharan Africa.
methodsThe synthesis model was used to address this aim. Three sub-populations were considered for CB-HIVST: (i) women having transactional sex (WTS); (ii) young people (15 to 24 years); and (iii) adult men (25 to 49 years). We assumed uptake of CB-HIVST similar to that reported in epidemiological studies (base case), or assumed people use CB-HIVST only if exposed to risk (condomless sex) since last HIV test. We also considered a five-year time-limited CB-HIVST programme. Cost-effectiveness was defined by an incremental cost-effectiveness ratio (ICER; cost-per-disability-adjusted life-year (DALY) averted) below US$500 over a time horizon of 50 years. The efficiency of targeted CB-HIVST was evaluated using the number of additional tests per infection or death averted.
resultsIn the base case, targeting adult men with CB-HIVST offered the greatest impact, averting 1500 HIV infections and 520 deaths per year in the context of a simulated country with nine million adults, and impact could be enhanced by linkage to voluntary medical male circumcision (VMMC). However, the approach was only cost-effective if the programme was limited to five years or the undiagnosed prevalence was above 3%. CB-HIVST to WTS was the most cost-effective. The main drivers of cost-effectiveness were the cost of CB-HIVST and the prevalence of undiagnosed HIV. All other CB-HIVST scenarios had an ICER above US$500 per DALY averted.
conclusionsCB-HIVST showed an important epidemiological impact. To maximize population health within a fixed budget, CB-HIVST needs to be targeted on the basis of the prevalence of undiagnosed HIV, sub-population and the overall costs of delivering this testing modality. Linkage to VMMC enhances its cost-effectiveness.
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