Offering the Choice of Self-Administered Oral HIV Testing (CHIVST) among Long-distance Truck Drivers in Kenya: A Trial-based Cost-effectiveness Analysis
Year: 2020
Type: article
Abstract: Background: Long distance truck drivers (LDTD) are a high-HIV-risk population facing unique healthcare barriers due to continuous travel and irregular schedules, and may require targeted, resource-intensive strategies for HIV-test uptake. We conducted a trial-based cost-effectiveness of CHIVST among LDTD in Kenya. Methods: Effectiveness data came from a randomized-controlled trial of CHIVST (n=150) versus provider-administered testing (n=155). Economic cost data came from the literature and reflected a societal perspective. Generalized Poisson and linear-gamma regression models estimated the effectiveness (relative-risk) and incremental costs (2017 I$), respectively, with incremental effectiveness calculated as the reciprocal of the absolute risk difference and reported as the number needing to receive CHIVST for an additional HIV-test uptake. We reported incremental cost-effectiveness ratios (ICERs), with 95%CIs calculated using Fieller’s theorem. Deterministic sensitivity analysis identified key cost drivers and cost-effectiveness acceptability curves assessed uncertainty in the ICER. We determined cost-effectiveness according to a willingness-to-pay threshold of 3xGDP per-capita of Kenya (I$9,774). Results: HIV-test uptake was 23% more likely for CHIVST versus provider-administered HIVtesting, with six individuals needing to be offered CHIVST for an additional HIV-test uptake (6.25, 95%CI 5.00-8.33). The mean cost per patient was more than double for CHIVST (I$26.56 vs I$10.47). The incremental cost-effectiveness of CHIVST was I$97.21 [95%CI 65.74-120.98] per additional HIV-test uptake compared to provider-administered HIV-testing. Self-test kits and Page | 59 patient time were the main cost drivers of the ICER. The probability of CHIVST being costeffective approached one at a willingness-to-pay threshold of I$140. Conclusion: CHIVST is an efficient use of resources compared to provider-administered testing.
Authors: Deo Mujwara, April D. Kimmel
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Virginia Commonwealth University, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, National Cancer Institute, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Institute of Diabetes and Digestive and Kidney Diseases, U.S. National Library of Medicine
OpenAlex ID: W3017450265