title: Assessment of the Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries.
abstract: BACKGROUND
  Studies have demonstrated that self-testing for human immunodeficiency virus (HIV) is highly acceptable among individuals and could allow cost savings, compared with provider-delivered HIV testing and counseling (PHTC), although the longer-term population-level effects are uncertain. We evaluated the cost-effectiveness of introducing self-testing in 2015 over a 20-year time frame in a country such as Zimbabwe.
  
  
  METHODS
  The HIV synthesis model was used. Two scenarios were considered. In the reference scenario, self-testing is not available, and the rate of first-time and repeat PHTC is assumed to increase from 2015 onward, in line with past trends. In the intervention scenario, self-testing is introduced at a unit cost of $3.
  
  
  RESULTS
  We predict that the introduction of self-testing would lead to modest savings in healthcare costs of $75 million, while averting around 7000 disability-adjusted life-years over 20 years. Findings were robust to most variations in assumptions; however, higher cost of self-testing, lower linkage to care for people whose diagnosis is a consequence of a positive self-test result, and lower threshold for antiretroviral therapy eligibility criteria could lead to situations in which self-testing is not cost-effective.
  
  
  CONCLUSIONS
  This analysis suggests that introducing self-testing offers some health benefits and may well save costs.
authors.affiliation: Research Department of Infection and Population Health.
authors.forename: Valentina
authors.initials: V
authors.lastname: Cambiano
authors.affiliation: MRC Clinical Trials Unit, University College London.
authors.forename: Deborah
authors.initials: D
authors.lastname: Ford
authors.affiliation: University of Zimbabwe Clinical Research Centre.
authors.forename: Travor
authors.initials: T
authors.lastname: Mabugu
authors.affiliation: Women's Global Health Imperative, RTI International, San Francisco, California.
authors.forename: Sue
authors.initials: S
authors.lastname: Napierala Mavedzenge
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.
authors.forename: Alec
authors.initials: A
authors.lastname: Miners
authors.affiliation: Ministry of Health and Child Welfare Zimbabwe, Harare.
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.affiliation: Research Department of Infection and Population Health.
authors.forename: Fumiyo
authors.initials: F
authors.lastname: Nakagawa
authors.affiliation: Centre for Health Economics, University of York, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Revill
authors.affiliation: Research Department of Infection and Population Health.
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D014943:Global Health / Q000191:economics; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D008954:Models, Biological; D011203:Poverty; D015995:Prevalence; D012648:Self Care / Q000191:economics*; D013269:Stochastic Processes; D013997:Time Factors; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; cost-effectiveness; diagnostic; mathematical modeling; self-testing