Costs of HIV testing services in sub-Saharan Africa: A systematic literature review
Abstract
Objective
To review HIV testing services (HTS) costs in sub-Saharan Africa.
Design
A systematic literature review of studies published from January 2006 to October 2020.
Methods
We searched ten electronic databases for studies that reported estimates for cost per person tested ($pptested) and cost per HIV-positive person identified ($ppositive) in sub-Saharan Africa. We explored variations in incremental cost estimates by testing modality (health facility-based, home-based, mobile-service, self-testing, campaign-style, and stand-alone), by primary or secondary/index HTS, and by population (general population, people living with HIV, antenatal care male partner, antenatal care/postnatal women and key populations). All costs are presented in 2019US$.
Results
Sixty-five studies reported 167 cost estimates. Most reported only $pptested (90%), while (10%) reported the $ppositive. Costs were highly skewed. The lowest mean $pptested was self-testing at $12.75 (median = $11.50); primary testing at $16.63 (median = $10.68); in the general population, $14.06 (median = $10.13). The highest costs were in campaign-style at $27.64 (median = $26.70), secondary/index testing at $27.52 (median = $15.85), and antenatal male partner at $47.94 (median = $55.19). Incremental $ppositive was lowest for home-based at $297.09 (median = $246.75); primary testing $352.31 (median = $157.03); in the general population, $262.89 (median: $140.13).
Conclusion
While many studies reported the incremental costs of different HIV testing modalities, few presented full costs. Although the $pptested estimates varied widely, the costs for stand-alone, health facility, home-based, and mobile services were comparable, while substantially higher for campaign-style HTS and the lowest for HIV self-testing. Our review informs policymakers of the affordability of various HTS to ensure universal access to HIV testing.
Authors
Ahmed N, Ong JJ, McGee K, d’Elbée M, Johnson C, Cambiano V, Hatzold K, Corbett EL, Terris-Prestholt F, Maheswaran H
Year
2024
Topics
- Population(s)
- General HIV+ population
- General HIV- population
- Testing
- Testing
- Health Systems
- Financial arrangements
