Katharina Hauck On behalf of the HPTN 071 Study Team

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Presentation transcript:

Katharina Hauck On behalf of the HPTN 071 Study Team COSTS OF HOME-BASED HIV TESTING IN ZAMBIA: EVIDENCE FROM THE HPTN 071 (PopART) STUDY Katharina Hauck On behalf of the HPTN 071 Study Team

Background 14.5 of the 36.7 million people living with HIV globally do not know their HIV status Testing critical first step in ending the epidemic Home-based testing and counselling (HBTC) Limited evidence on the costs of HBTC Cost per person tested: $5.80 to $38.80 Cost per person tested positive: $42.40 to $454.40 The HPTN 071 (PopART) trial

HPTN 071 (PopART) Trial in 12 communities in Zambia (and 9 in South Africa) Cluster randomized trial Combination prevention package Impact on HIV incidence HBTC delivered by 412 community HIV-care providers (CHiPs) CHIPs work in pairs

Research question Costs of HBTC under HPTN071 (PopART) Estimates of total costs per year cost per person tested cost per person testing positive Data from 8 communities in Zambia HBTC delivered to over 250,000 individuals Between December 2013 and December 2016

Methodology Micro-costing methods Data on salaries, equipment, supplies, transport, and general administration from program records Merged with outcome indicators from program data Allocation rules to communities Personnel costs by number of CHiPs teams HIV testing costs by number of tests other costs by population covered

Methodology Equivalent annual costs for equipment and training over the lifetime of the study Inflation-adjusted in 2016 US$ Probabilistic sensitivity analysis by random sampling from specified distributions Costs are presented as means from the simulations

Findings 1st round 2nd round 126,208 individuals tested 9,196 (7%) tested HIV-positive (of those tested) 2nd round 136,966 individuals tested 4,921 (3.6%) tested HIV-positive (of those tested)

Findings

Findings

Interpretation Costs are sensitive to community-specific factors related to service delivery population characteristics Cost per person tested HIV-positive nearly doubled between rounds Partly explained by a reduction in positivity rate Further analysis required to evaluate the cost-effectiveness of HBTC

acknowledgements Sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) under Cooperative Agreements # UM1 AI068619, UM1-AI068617, and UM1-AI068613 Funded by: The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) The International Initiative for Impact Evaluation (3ie) with support from the Bill & Melinda Gates Foundation NIAID, the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) all part of the U.S. National Institutes of Health (NIH)

The HPTN 071 Study Team, led by: PEPFAR Implementing Partners: Dr. Richard Hayes Dr. Sarah Fidler Dr. Helen Ayles Dr. Nulda Beyers Dr. Peter Bock Government Agencies: PEPFAR Implementing Partners:

With thanks to: All research participants and their families The 21 research communities and their religious, traditional, secular and civil leadership structures Volunteers in the community advisory board structures