1. Comparison of HIV self-testing (HIVST) costs in Zambia:
UNITAID PSI HIV SELF-TESTING AFRICA
Comparison of HIV self-testing (HIVST) costs in Zambia:
a question of scale and scope?
Lawrence Mwenge, MSc
Nurilign Ahmed, Linda Sande, Collin Mangenah, Marc d’Elbée, Sarah Kanema, Jason J. Ong, Mutinta Nalubamba, Sepiso Libamba, Hambweka Munkombwe, Pitchaya Indravudh, Euphemia Sibanda, Hendramoorthy Maheswaran, Cheryl Johnson, Karin Hatzold, Liz E. Corbett, Helen Ayles, Fern Terris-Prestholt
10th IAEN Pre-conference
Amsterdam, July 2018

2. Background Part of economic evaluation of STAR phase 1 implementation
Implemented 3 distribution models in Zambia:
Community-based distribution agents (CBDAs)
Voluntary medical male circumcision (VMMC)
Health facility (HF) models.

3. STUDY QUESTIONS
What are the costs of delivering HIVST across three delivery approaches in Zambia:
Community based,
Facility based, and
VMMC sites.
Does the data suggest:
Economies of Scale, or
Economies of Scope?
Consider implications for scale up

4. Methodology - Costing
Full prospective economic costing from provider’s perspective
Costing period: July May 2017 in 16 communities
Detailed top-down costing
Supplemented by field observations to obtain allocation factors and opportunity costs
Capital annualized (DR: 3%)
All costs are presented in 2017 US$
Economies of scale
Economies of scope
Compare means and range in sites with
2 and 3 distribution approaches offered

5. Methodology - Setting 16 sites in four districts;
Ndola (Copperbelt province)
Kapiri Mposhi (Central province)
Lusaka (Lusaka province)
Choma (Southern province)
District
CBDA
VMMC HF
Ndola (4 sites) 4
Kapiri Mposhi (4 sites) 3
Lusaka (4 sites) 1
Choma (4 sites)

6. Results – HIVST kits distributed & costs
STAR models distributed 127,804 HIVST kits;
CDBA (81%)
VMMC (9%)
Health Facility (10%)
Model
HIVST Kits distributed
Costs(US$)
Total (US$)
$/kit distributed
CBDA
103,589
$1,508,109
$14.56
VMMC
11,330
$ 143,274
$12.65
Health Facility
12,885
$ 183,313
$14.23
CBDA distributor numbers:
138 in Malawi, 139 long-term in Zambia, & 1,009 short-term in Zimbabwe

7. Results – Cost components
CBDA distributor numbers:
138 in Malawi, 139 long-term in Zambia, & 1,009 short-term in Zimbabwe

8. Results – economies of scale
Economies of scale were present
Where health facility model distributed less kits, UC appears higher
Mean
$14.23
Range
$4-$42
No. of sites 16
CBDA distributor numbers:
138 in Malawi, 139 long-term in Zambia, & 1,009 short-term in Zimbabwe

9. …Results – economies of scale
VMMC model shows similar pattern
Mean
$12.65
$14.23
Range
$8-$25
$6-$36
No. of sites 8 16
CBDA distributor numbers:
138 in Malawi, 139 long-term in Zambia, & 1,009 short-term in Zimbabwe

10. …Results – economies of scale
Strongly suggestive of economies of scale
CBDA model had higher costs, but higher distribution,
Mean
$12.65
$14.56
$14.23
Range
$8-$25
$6-$36
$4-$42
CBDA distributor numbers:
138 in Malawi, 139 long-term in Zambia, & 1,009 short-term in Zimbabwe

11. Results - Economies of Scope
Due to high shared costs, expectation of economies of scope
Mean
$13.48
$14.88
Range
$9-$23
$10-$37 n= 8

12. Results - Economics of Scope
Due to high shared costs, expectation of economies of scope, but sample of sites small
Mean
$13.48
$14.88
Range
$9-$23
$10-$37 n= 8

13. Conclusion Costs per kit distributed similar across 3 models
$12-$15, but with very large variation by scale.
Costs of conventional HTS in same sites: $4.24
Impact of static models constrained by client population size
To reach large numbers need to step outside clinics.
As saturation is reached,
lessons from costing smaller scale sites
expect unit costs to ↑
→Important consideration when planning scale up

14. Further research
Analysis feeds into CE modelling to consider best combination of testing strategies in Zambia Ahmed, et al.
Statistically test for econs of scope, scale & other drivers:
→ cost functions using pooled data across STAR countries
See also:
Mangenah – HIVST cross country cost analysis Poster Outside
Ahmed – Systematic Review of HIV testing costs TEPEE613
D’Elbee – HIVST distribution preference Poster Outside
Mwenge 2017 Cross country HTS costing PlosOne
D’Elbee – Post testing linkage preferences 2018 AIDS

15. Thank you Acknowledgements The study was funded by Unitaid through PSI
Participating sites
Ministry of Health
IAEN for funding this dissemination
Thank you
Contact
Lawrence Mwenge
Zambart