Table 2.
Summary of HTS cost studies undertaken in sub-Saharan Africa between 2006–2020 (N = 65)
| Number of studies (N) (%) | Cost Estimates (n) (%) | Mean incremental cost per person tested ($) (Median IQR) (n) | Mean incremental cost per positive person tested ($) (Median IQR) (n) |
|---|---|---|---|
| Total (N = 65) | 167 (100%) | $18.45 (median = $12.26, IQR: $7.64–$23.50) (n = 124) | $359.76 (median = $168.80, IQR: $80.08–$403.74) (n = 71) |
| Sub-Saharan African Countries | |||
| Kenya (N = 11) (17%) | $25.11 (median = $15.65, IQR: $12.78–$37.33) (n = 15) | $178.56(median = $116.80, IQR: $66.84–$168.80) (n = 9) | |
| Malawi (N = 9) (14%) | $13.03 (median = $9.82 IQR: $6.25–$12.84 (n = 19) | $149.00 (median = $121.64, IQR: $96.84–$169.16) (n = 11) | |
| South Africa (N = 11) (17%) | $25.91 (median = $13.38, IQR: $7.38–$29.96) (n = 22) | $409.78 (median = $156.45, IQR: $19.01–$723.11) (n = 23) | |
| Uganda (N = 11) (17%) | $13.76 (median = $10.95, IQR: $6.43–$15.64) (n = 26) | $226.26 (median = $148.40, IQR: $82.10–$246.75) (n = 13) | |
| Zambia (N = 5) (8%) | $21.08 (median = $14.07, IQR: $7.13–$26.43) (n = 14) | $345.71 (median = $390.39, IQR: $85.43–$522.94) (n = 8) | |
| Other West African countries (N = 4) (6%) | $22.55 (median = $16.96, IQR: $9.19–$34.09) (n = 8) | $1,297.86(median = $931.18, IQR: $444.57–$1,784.47) (n = 4) | |
| Other Southern African countries (N = 34) (53%) | $19.05 (median = $12.13, IQR: $7.29–$19.68) (n = 65) | $290.63 (median = $156.45, IQR: $72.26–$403.74) (n = 39) | |
| Other Eastern African countries (N = 26) (41%) | $20.28 (median = $12.44, IQR: $8.11–$18.84) (n = 51) | $322.03 (median = $161.60, IQR: $85.38–$339.46) (n = 32) | |
| Country Income Level | |||
| Low Income (N = 21) (33%) | $13.97 (median = $10.43, IQR: $6.18–$15.42) (n = 50) | $293.71 (median = $144.27, IQR: $92.70–$241.97) (n = 26) | |
| Lower-middle Income (N = 29) (45%) | $19.60 (median = $13.96, IQR: $8.31–$25.76) (n = 53) | $393.10 (median = $243.97, IQR: $88.63–$452.96) (n = 31) | |
| Upper-middle Income (N = 14) (22%) | $25.91 (median = $13.38, IQR: $7.38–$29.96) (n = 19) | $409.78 (median = $156.45, IQR: $19.01–$723.11) (n = 11) | |
| Country HIV prevalence (year of costing) | |||
| < 5% (N = 5) (8%) | $21.05 (median = $13.36, IQR: $9.49–$30.49) (n = 13) | $1,374.57 (median = $1,309.58, IQR: $665.45–$1,713.74) (n = 6) | |
| 5–10% (N = 29) (45%) | $15.59 (median = $10.95, IQR: $6.39–$16.27) (n = 52) | $217.52 (median = $148.40, IQR: $95.79–$237.19) (n = 31) | |
| 10–15% (N = 15) (23%) | $17.38 (median = $12.79, IQR: $7.93–$15.83) (n = 34) | $225.66 (median = $113.04, IQR: $73.66–$393.67) (n = 17) | |
| 15–20% (N = 9) (14%) | $29.99 (median = $23.35, IQR: $7.08–$48.85) (n = 17) | $48,125 (median = $356.22, IQR: $22.24–$864.86) (n = 11) | |
| 20–25% (N = 5) (8%) | $14.11 (median = $14.08, IQR: $13.72–$14.46) (n = 4) | $300.13 (median = $300.13, IQR: $253.42–$346.84) (n = 2) | |
| 25–30% (N = 1) (2%) | $11.58 (median = $9.33, IQR: $8.75–$12.16) (n = 4) | $205.48 (median = $165.07, IQR: $48.33–$322.21) (n = 4) | |
| Cost Year | |||
| 2000–2005 (N = 3) (5%) | $15.28 (median = $15.51, IQR: $14.22–$16.57) (n = 4) | ||
| 2005–2010 (N = 14) (22%) | $16.34 (median = $11.77, IQR: $8.15–$15.12) (n = 27) | $116.91 (median = $94.62, IQR: $48.33–$152.09) (n = 16) | |
| 2010–2015(N = 25) (39%) | $20.32 (median = $14.03, IQR: $8.23–$28.63) (n = 60) | $465.55 (median = $203.97, IQR: $86.47–$512.75) (n = 33) | |
| 2015–2020 (N = 22) (34%) | $17.16 (median = $10.08, IQR: $5.73–$14.23) (n = 34) | $377.69 (median = $352.88, IQR: $131.77–$506.29) (n = 19) | |
| HTS Modality | |||
| Campaign style (N = 5) (8%) | $27.64 (median = $26.70, IQR: $12.42–$41.93) (n = 4) | $413.14 (median = $388.70, IQR: $258.16–$555.91) (n = 3) | |
| Health facility based (N = 34) (53%) | $19.63 (median = $10.70, IQR: $6.00–$28.63) (n = 56) | $398.95 (median = $148.29, IQR: $69.85–$429.42) (n = 32) | |
| ANC/PMTCT (N = 6) (18%) | $42.74 (median = $46.75, IQR: $16.24–$66.62) (n = 9) | $967.23 (median = $518.84, IQR: $399.42–$1,039.32) (n = 8) | |
| VCT (N = 16) (47%) | $14.68 (median = $10.71, IQR: $6.18–$16.02) (n = 26) | $276.35 (median = $122.62, IQR: $72.96–$171.74) (n = 16) | |
| Integrated (N = 5) (15%) | $33.77 (median = $18.40, IQR: $14.21–$47.91) (n = 7) | $19.31 (median = $19.31, IQR: $19.31–$19.31) (n = 3) | |
| OPD (N = 7) (21%) | $6.91 (median = $6.53, IQR: $3.14–$8.09) (n = 13) | $83.96 (median = $66.84, IQR: $35.45–$125.31) (n = 5) | |
| Home-based (N = 13) (20%) | $19.30 (median = $13.42, IQR: $8.34–$23.35) (n = 29) | $297.09 (median = $246.75, IQR: $132.60–$381.62) (n = 15) | |
| Mobile service (N = 5) (8%) | $16.47 (median = $12.88, IQR: $9.88–$23.94) (n = 13) | $356.93 (median = $206.71, IQR: $126.32–$387.29) (n = 11) | |
| Self-testingd (N = 6) (9%) | $12.75 (median = $11.50, IQR: $9.27–$13.92) (n = 19) | $338.57 (median = $113.04, IQR: $78.06–$516.30) (n = 9) | |
| Community based (N = 1) (17%) | $9.83 (median = $9.84, IQR: $5.48–$14.17) (n = 6) | $529.59 (median = $529.59, IQR: $522.94–$536.23) (n = 2) | |
| Facility based (N = 4) (67%) | $10.70 (median = $10.55, IQR: $10.18–$12.25) (n = 9) | $92.00 (median = $83.32, IQR: $44.12–$106.92) (n = 6) | |
| Home-based (N = 1) (17%) | $21.76 (median = $14.03, IQR: $12.83–$22.96) (n = 4) | $1,435.94 (median = $1,435.94, IQR: $1,435.94–$1,435.94) (n = 1) | |
| Stand-alone (N = 1) (2%) | $20.61 (median = $20.52, IQR: $15.10–$26.08) (n = 3) | $107.15 (median = $107.15, IQR: $107.15–$107.15) (n = 1) | |
| HTS type | |||
| Direct (N = 57) (89%) | $16.71 (median = $10.95, IQR: $7.24–$18.72) (n = 104) | $340.16 (median = $161.60, IQR: $79.07–$393.64) (n = 66) | |
| Secondary/Indexa (N = 7) (11%) | $27.52 (median = $15.85, IQR: $14.41–$38.88) (n = 20) | $618.48 (median = $356.22, IQR: $246.75–$1,041.58) (n = 5) | |
| Testing population | |||
| General population(s)b (N = 10) (16%) | $14.39 (median = $10.25, IQR: $7.00–$15.52) (n = 92) | $255.40(median = $148.40, IQR: $72.26–$348.18) (n = 59) | |
| PLHIV Partners (N = 3) (5%) | $19.31 (median = $15.57, IQR: $14.86–$27.09) (n = 14) | $246.75 (median = $246.75, IQR: $246.75–$246.75) (n = 1) | |
| ANC/PMTCT Male Partners (N = 3) (5%) | $47.94 (median = $49.17, IQR: $13.39–$55.19) (n = 5) | $711.41 (median = $698.90, IQR: $270.14–$1,140.17) (n = 4) | |
| Pregnant women or women breastfeeding (N = 5) (8%) | $39.25 (median = $41.32, IQR: $14.08–$62.39) (n = 10) | $1,054.52 (median = $524, IQR: $463.28–$1,300.53) (n = 7) | |
| Key Population(s)c (N = 2) (3%) | $20.31 (median = $9.49, IQR: $8.00–$27.21) (n = 3) | – | |
| Type of Cost Analysis | |||
| Incremental vs. Full (N = 49 vs. 15) (77% vs.23%) | Incremental | $18.45 (median = $12.26, IQR: $7.64–$23.50) (n = 124) | $359.76 (median = $168.80, IQR: $80.08–$403.73) (n = 71) |
| Full | $38.65 (median = $32.83, IQR: $25.47–$45.69) (n = 33) | $367.43 (median = $322.92, IQR: $85.22–$582.91) (n = 16) | |
| Financial vs. Economic (N = 30 vs. 34) (47% vs.53%) | Financial | $19.13 (median = $13.11, IQR: $7.52–$12.88) (n = 72) | $334.37 (median = $237.19, IQR: $79.28–$449.47) (n = 40) |
| Economic | $25.71 (median = $15.97, IQR: $9.82–$35.00) (n = 85) | $383.98 (median = $157.03, IQR: $82.27–$494.50) (n = 47) | |
| Empirical vs. Modelled (N = 61 vs. 3) (95% vs.5%) | Empirical | $22.96 (median = $14.49, IQR: $8.76–$31.53) (n = 154) | $363.93 (median = $177.58, IQR: $81.09–$474.91) (n = 84) |
| Modelled | $9.01(median = $7.60, IQR: $5.49–$11.82) (n = 3) | $283.75 (median = $349.54, IQR: $187.50–$412.89) (n = 3) | |
Western A.U. countries (Nigeria) (N = 4), Southern AU countries (Botswana, Eswatini, Lesotho, Namibia, South Africa, Zambia, Zimbabwe (N = 35), Eastern A.U. countries (Ethiopia, Kenya, Rwanda, Tanzania, Uganda (N = 26)
aSecondary index testing focused on testing sexual partner(s) of HIV-positive individuals
bGeneral population represented those people considered at risk of HIV acquisition and therefore deserving of HIV testing
cNo study reported cost per positive case identified for key populations. “UNAIDS considers gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people as the five main key population groups that are particularly vulnerable to HIV and frequently lack adequate access to services.” Male truckers would fall into UNAID’s definition of vulnerable populations but not key populations[41]
dThe cost per positive case identified includes the cost of confirmatory testing for those who reported positive HIV self-testing, except for one study [42], which was not clearly stated