Maheswaran, H., Petrou, S., MacPherson, P., et al. Journal of Acquired Immune Deficiency Syndromes (March 2017), e-publication ahead of print, doi:10.1097/QAI.0000000000001373.
This study in Malawi compared the economic and health outcomes of HIV self-testing (HIVST)—a recommended approach in Africa—with outcomes of facility-based HIV testing and counseling (HTC). The authors conducted a prospective cohort study of 325 HIV-positive participants who had been diagnosed through HIVST (60) or facility-based HTC (265) as part of a community cluster-randomized trial (ISRCTN02004005). They followed these participants for one year from initiation on antiretroviral therapy (ART) and measured health care resource use, health provider costs, direct nonmedical and indirect costs, and health-related quality of life (using the EuroQol EQ-5D tool) during this period. Mean total health provider assessment costs for ART initiation were USD$22.79 and $19.92 for HTC and HIVST participants, respectively. Health provider costs for the first year of ART were $168.65 and $164.66, respectively, for facility-based HTC and HIVST participants. EQ-5D utility scores were comparable between the two groups; quality of life was lower among those with lower CD4 counts but improved after ART initiation, irrespective of the HIV testing mode. The authors concluded that after HIV self-testers are linked to HIV services, their economic and health outcomes are comparable to those linking to services after facility-based HTC, but they cautioned that the high cost of ART could limit adherence.