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. 2024 Jul;27(7):e26334.
doi: 10.1002/jia2.26334.

Cost-effectiveness analysis of community-led HIV self-testing among key populations in Côte d'Ivoire, Mali, and Senegal

Ingrid Jiayin Lu  1 , Romain Silhol  2 , Marc d'Elbée  3   4 , Marie-Claude Boily  2 , Nirali Soni  2 , Odette Ky-Zerbo  5 , Anthony Vautier  6 , Artlette Simo Fosto  7   8 , Kéba Badiane  6 , Metogara Traoré  9   10   11 , Fern Terris-Prestholt  12 , Joseph Larmarange  4   6 , Mathieu Maheu-Giroux  1 ; ATLAS Team
Affiliations

Cost-effectiveness analysis of community-led HIV self-testing among key populations in Côte d'Ivoire, Mali, and Senegal

Ingrid Jiayin Lu et al. J Int AIDS Soc. 2024 Jul.

Abstract

Introduction: HIV self-testing (HIVST) is a promising strategy to improve diagnosis coverage among key populations (KP). The ATLAS (Auto Test VIH, Libre d'Accéder à la connaissance de son Statut) programme implemented HIVST in three West African countries, distributing over 380,000 kits up between 2019 and 2021, focussing on community-led distribution by KP to their peers and subsequent secondary distribution to their partners and clients. We aim to evaluate the cost-effectiveness of community-led HIVST in Côte d'Ivoire, Mali and Senegal.

Methods: An HIV transmission dynamics model was adapted and calibrated to country-specific epidemiological data and used to predict the impact of HIVST. We considered the distribution of HIVST among two KP-female sex workers (FSW), and men who have sex with men (MSM)-and their sexual partners and clients. We compared the cost-effectiveness of two scenarios against a counterfactual without HIVST over a 20-year horizon (2019-2039). The ATLAS-only scenario mimicked the 2-year implemented ATLAS programme, whereas the ATLAS-scale-up scenario achieved 95% coverage of HIVST distribution among FSW and MSM by 2025 onwards. The primary outcome is the number of disability-adjusted life-years (DALY) averted. Scenarios were compared using incremental cost-effectiveness ratios (ICERs). Costing was performed using a healthcare provider's perspective. Costs were discounted at 4%, converted to $USD 2022 and estimated using a cost-function to accommodate economies of scale.

Results: The ATLAS-only scenario was highly cost-effective over 20 years, even at low willingness-to-pay thresholds. The median ICERs were $126 ($88-$210) per DALY averted in Côte d'Ivoire, $92 ($88-$210) in Mali and 27$ ($88-$210) in Senegal. Scaling-up the ATLAS programme would also be cost-effective, and substantial epidemiological impacts would be achieved. The ICERs for the scale-up scenario were $199 ($122-$338) per DALY averted in Côte d'Ivoire, $224 ($118-$415) in Mali and $61 ($18-$128) in Senegal.

Conclusions: Both the implemented and the potential scale-up of community-led HIVST programmes in West Africa, where KP are important to overall transmission dynamics, have the potential to be highly cost-effective, as compared to a scenario without HIVST. These findings support the scale-up of community-led HIVST to reach populations that otherwise may not access conventional testing services.

Keywords: HIV testing services; HIV‐self testing; community‐led delivery; cost function; cost‐effectiveness; key population.

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Conflict of interest statement

The authors have no conflicts of interest that are directly relevant to the content of this article.

Figures

Figure 1
Figure 1
Cost‐effectiveness acceptability curves for ATLAS‐only (solid lines) and ATLAS‐scale‐up (dotted lines) scenarios over 20 years. The vertical dashed lines correspond to the country‐specific thresholds ($155 for Mali, and $488 for Côte d'Ivoire and Senegal). The curves represent the proportion of the simulations that are below a specific willingness to pay threshold.
See this image and copyright information in PMC

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