A community-based organisation-led HIV self-testing program among men who have sex with men in China is cheaper and more effective than facility-based HIV testing: an economic evaluation†
Shanzi Huang A # , Jason J. Ong
B C # , Wencan Dai A , Xi He D , Yi Zhou A , Xiaofeng Li A , Liqun Huang A § and Weiming Tang E F § *
+ Author Affiliations
- Author Affiliations
A Zhuhai Center for Diseases Control and Prevention, Zhuhai, China.
B Central Clinical School, Monash University, Carlton, Vic., Australia.
C London School of Hygiene and Tropical Medicine, London, UK.
D Zhuhai Xutong Voluntary Services Center, Zhuhai, China.
E Dermatology Hospital, Southern Medical University, Guangzhou, China.
F The University of North Carolina at Chapel Hill Project-China, Guangzhou, China.
* Correspondence to: Weiming_tang@med.unc.edu, weimingtangscience@gmail.com
Handling Editor: Ligang Yang
Sexual Health 19(5) 464-472 https://doi.org/10.1071/SH22010
Submitted: 14 January 2022 Accepted: 25 May 2022 Published: 23 June 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing
Abstract
Background: HIV self-testing (HIVST) is effective in improving the uptake of HIV testing among key populations. Complementary data on the economic evaluation of HIVST is critical for planning and scaling up HIVST. This study aimed to evaluate the cost of a community-based organisation (CBO)-led HIVST model implemented in China.
Methods: An economic evaluation was conducted by comparing a CBO-led HIVST model with a CBO-led facility-based HIV rapid diagnostics testing (HIV-RDT) model. The full economic cost, including fixed and variable cost, from a health provider perspective using a micro costing approach was estimated. We determined the incremental cost-effectiveness ratios of these two HIV testing models over a 2-year time horizon (i.e. duration of the programs), and reported costs using US dollars (2021).
Results: From January 2017 to December 2018, a total of 4633 men were tested in the HIVST model, and 1780 men were tested in the HIV-RDT model. The total number of new diagnoses was 155 for HIVST and 126 for the HIV-RDT model; the HIV test positivity was 3.3% (95% confidence interval (CI): 2.8–3.9) for the HIVST model and 7.1% (95% CI: 5.9–8.4) for the HIV-RDT model. The mean cost per person tested was USD10.38 for HIVST and USD41.45 for HIV-RDT. The mean cost per diagnosed person was USD310.12 for HIVST compared with USD585.58 for HIV-RDT.
Conclusion: Compared to facility-based HIV-RDT, a CBO-led HIVST program is cheaper and more effective among MSM living in China.
Keywords: China, community-based model, economic evaluation, facility-based HIV testing, HIV, HIV self-testing, implementation, men who have sex with men (MSM).
References
[1] Dong M-J, Peng B, Liu Z-F, Ye Q-n, Liu H, Lu X-L, et al. The prevalence of HIV among MSM in China: a large-scale systematic analysis. BMC Infect Dis 2019; 19 1000| The prevalence of HIV among MSM in China: a large-scale systematic analysis.Crossref | GoogleScholarGoogle Scholar | 31775654PubMed |
[2] Frye V, Koblin BA. HIV self-testing in high-risk populations. Lancet HIV 2017; 4 e232–3.
| HIV self-testing in high-risk populations.Crossref | GoogleScholarGoogle Scholar | 28219618PubMed |
[3] SESH Study Group Tucker JD. Crowdsourcing to promote HIV testing among MSM in China: study protocol for a stepped wedge randomized controlled trial. Trials 2017; 18 447
| Crowdsourcing to promote HIV testing among MSM in China: study protocol for a stepped wedge randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 28969702PubMed |
[4] Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and acceptability on HIV self-testing among key populations: a literature review. AIDS Behav 2015; 19 1949–65.
| Attitudes and acceptability on HIV self-testing among key populations: a literature review.Crossref | GoogleScholarGoogle Scholar | 26054390PubMed |
[5] Napierala Mavedzenge S, Baggaley R, Corbett EL. A review of self-testing for HIV: research and policy priorities in a new era of HIV prevention. Clin Infect Dis 2013; 57 126–38.
| A review of self-testing for HIV: research and policy priorities in a new era of HIV prevention.Crossref | GoogleScholarGoogle Scholar | 23487385PubMed |
[6] Zhao Y, Zhu X, Perez AE, Zhang W, Shi A, Zhang Z, et al. MHealth approach to promote Oral HIV self-testing among men who have sex with men in China: a qualitative description. BMC Public Health 2018; 18 1146
| MHealth approach to promote Oral HIV self-testing among men who have sex with men in China: a qualitative description.Crossref | GoogleScholarGoogle Scholar | 30261856PubMed |
[7] Eustaquio PC, Figuracion R, Izumi K, Morin MJ, Samaco K, Flores SM, et al. Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: a retrospective cohort study. BMC Public Health 2022; 22 366
| Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar | 35189850PubMed |
[8] China Internet Network Information Center (CNNIC). The 44th China internet development statistics report. 2019. Available at http://www.cnnic.net.cn/hlwfzyj/
[9] Tang W, Best J, Zhang Y, Liu F-y, Tso LS, Huang S, et al. Gay mobile apps and the evolving virtual risk environment: a cross-sectional online survey among men who have sex with men in China. Sex Transm Infect 2016; 92 508–14.
| Gay mobile apps and the evolving virtual risk environment: a cross-sectional online survey among men who have sex with men in China.Crossref | GoogleScholarGoogle Scholar | 27288414PubMed |
[10] Tun W, Vu L, Dirisu O, Sekoni A, Shoyemi E, Njab J, et al. Uptake of HIV self-testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: a pilot programme using key opinion leaders to reach MSM. J Int AIDS Soc 2018; 21 e25124
| Uptake of HIV self-testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: a pilot programme using key opinion leaders to reach MSM.Crossref | GoogleScholarGoogle Scholar | 30033680PubMed |
[11] UNAIDS and Stop AIDS Alliance. Communities deliver. The critical role of communities in reaching global targets to end the AIDS epidemic. 2015. Available at https://www.unaids.org/sites/default/files/media_asset/UNAIDS_JC2725_CommunitiesDeliver_en.pdf
[12] Lu X, Gao P, Wang X, Wang X, Zhao X, He Q, et al. User preferences for an mHealth approach to support HIV self-testing and linkage to HIV prevention or care services for MSM in China. AIDS Educ Prev 2021; 33 534–50.
| User preferences for an mHealth approach to support HIV self-testing and linkage to HIV prevention or care services for MSM in China.Crossref | GoogleScholarGoogle Scholar | 34874759PubMed |
[13] Ritchwood TD, He J, Smith MK, Tang W, Ong JJ, Oduro A, et al. “Getting to Zero” among men who have sex with men in China: a review of the HIV care continuum. Curr HIV/AIDS Rep 2019; 16 431–8.
| “Getting to Zero” among men who have sex with men in China: a review of the HIV care continuum.Crossref | GoogleScholarGoogle Scholar | 31792704PubMed |
[14] Tang W, Wu D. Opportunities and challenges for HIV self-testing in China. Lancet HIV 2018; 5 e611–2.
| Opportunities and challenges for HIV self-testing in China.Crossref | GoogleScholarGoogle Scholar | 30213725PubMed |
[15] Yi Z, Yawei L, Xi H, Shanzi H, Xiaofeng L, Wencan D. Estimation of the population size of who have sex with men in different venues of Zhuhai city. Chin J AIDS STD 2017; 23 730–3.
[16] Qi T, Hongzhou L. Challenges for ending the AIDS pandemic in China. J Microbes Infect 2019; 14 129–36.
[17] Shrestha RK, Chavez PR, Noble M, Sansom SL, Sullivan PS, Mermin JH, et al. Estimating the costs and cost-effectiveness of HIV self-testing among men who have sex with men, United States. J Int AIDS Soc 2020; 23 e25445
| Estimating the costs and cost-effectiveness of HIV self-testing among men who have sex with men, United States.Crossref | GoogleScholarGoogle Scholar | 31960580PubMed |
[18] Heendeniya A, Tumarkin E, Bogoch II. HIV preexposure prophylaxis in Canadian primary care and community settings. Can Fam Physician 2019; 65 271–2.
| 30979761PubMed |
[19] The World Bank. Inflation, consumer prices (annual %) - China. 2022. Available at https://data.worldbank.org/indicator/FP.CPI.TOTL.ZG?end=2018&locations=CN&start=2017
[20] OANDA. Currency converter. 2022. Available at https://www1.oanda.com/currency/converter/
[21] Johnson LF, van Rensburg C, Govathson C, Meyer-Rath G. Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness. Sci Rep 2019; 9 12621
| Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness.Crossref | GoogleScholarGoogle Scholar | 31477764PubMed |
[22] Cambiano V, Ford D, Mabugu T, Napierala Mavedzenge S, Miners A, Mugurungi O, et al. Assessment of the potential impact and cost-effectiveness of self-testing for HIV in low-income countries. J Infect Dis 2015; 212 570–7.
| Assessment of the potential impact and cost-effectiveness of self-testing for HIV in low-income countries.Crossref | GoogleScholarGoogle Scholar | 25767214PubMed |
[23] Cambiano V, Johnson CC, Hatzold K, Terris-Prestholt F, Maheswaran H, Thirumurthy H, et al. The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis. J Int AIDS Soc 2019; 22 e25243
| The impact and cost-effectiveness of community-based HIV self-testing in sub-Saharan Africa: a health economic and modelling analysis.Crossref | GoogleScholarGoogle Scholar | 30907498PubMed |
[24] Beyrer C, Sullivan P, Sanchez J, Baral SD, Collins C, Wirtz AL, et al. The increase in global HIV epidemics in MSM. AIDS 2013; 27 2665–78.
| The increase in global HIV epidemics in MSM.Crossref | GoogleScholarGoogle Scholar | 23842129PubMed |
[25] Pachankis JE, Hatzenbuehler ML, Hickson F, Weatherburn P, Berg RC, Marcus U, et al. Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS 2015; 29 1239–46.
| Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey.Crossref | GoogleScholarGoogle Scholar | 26035323PubMed |
[26] MacGowan RJ, Chavez PR, Borkowf CB, Owen SM, Purcell DW, Mermin JH, et al. Effect of internet-distributed HIV self-tests on HIV diagnosis and behavioral outcomes in men who have sex with men: a randomized clinical trial. JAMA Intern Med 2020; 180 117–25.
| Effect of internet-distributed HIV self-tests on HIV diagnosis and behavioral outcomes in men who have sex with men: a randomized clinical trial.Crossref | GoogleScholarGoogle Scholar | 31738378PubMed |
[27] Yi Z, Lin D, Wencan D, Yang Y, Xi H, Yan L. Result analysis of inter-base HIV self-testing among MSM in Zhuhai city. Chin J AIDS STD 2017; 23 1128–30.
[28] Long RX, You WZ, Dong MG, Jennifer M, Ming RK, Yan Z. Uptake of HIV self-testing among men who have sex with men in Beijing, China: a cross-sectional study. Biomed Environ Sci 2017; 30 407–17.
| Uptake of HIV self-testing among men who have sex with men in Beijing, China: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
[29] Jin X, Xu J, Smith MK, Xiao D, Rapheal ER, Xiu X, et al. An Internet-Based Self-Testing Model (Easy Test): cross-sectional survey targeting men who have sex with men who never tested for HIV in 14 Provinces of China. J Med Internet Res 2019; 21 e11854
| An Internet-Based Self-Testing Model (Easy Test): cross-sectional survey targeting men who have sex with men who never tested for HIV in 14 Provinces of China.Crossref | GoogleScholarGoogle Scholar | 31094339PubMed |
[30] Harichund C, Karim QA, Kunene P, Simelane S, Moshabela M. Exploring factors that influence the integration of HIVST with HCT using a qualitative comparative cross-over design in KwaZulu-Natal, South Africa. Global Public Health 2019; 14 1275–87.
| Exploring factors that influence the integration of HIVST with HCT using a qualitative comparative cross-over design in KwaZulu-Natal, South Africa.Crossref | GoogleScholarGoogle Scholar | 30829120PubMed |
[31] Jamil MS, Prestage G, Fairley CK, Grulich AE, Smith KS, Chen M, et al. Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial. Lancet HIV 2017; 4 e241–50.
| Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 28219619PubMed |
[32] El-Sadr WM, Mayer KH, Rabkin M, Hodder SL. AIDS in America — back in the headlines at long last. N Engl J Med 2019; 380 1985–7.
| AIDS in America — back in the headlines at long last.Crossref | GoogleScholarGoogle Scholar | 31042822PubMed |
[33] Phillips AN, Cambiano V, Nakagawa F, Bansi-Matharu L, Wilson D, Jani I, et al. Cost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa: health economic and modelling analysis. J Int AIDS Soc 2019; 22 e25325
| Cost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa: health economic and modelling analysis.Crossref | GoogleScholarGoogle Scholar | 31287620PubMed |
[34] Neuman M, Taegtmeyer M, Hatzold K, Johnson CC, Weiss HA, Fielding K.. Challenges in measurement of linkage following HIV self-testing: examples from the STAR Project. J Int AIDS Soc 2019; 22 e25238
| Challenges in measurement of linkage following HIV self-testing: examples from the STAR Project.Crossref | GoogleScholarGoogle Scholar | 30907491PubMed |
