Cost-Effectiveness of the I'm Ready HIV Self-Testing Programme Among High-Risk Populations in Canada

IF 4.9 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2026-04-07 DOI:10.1002/jia2.70097

Lisa Masucci, Hawre Jalal, Sean B. Rourke, Kristin McBain, Min Xi, Wei Zhang, Hai V. Nguyen, William W. L. Wong, M. John Gill, Alice Zwerling, Kednapa Thavorn

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引用次数: 0

Abstract

Introduction

While HIV self-testing (HIVST) presents a promising solution for early HIV detection, access to such testing remains limited in Canada. Achieving the United Nations 95% target for HIV status awareness requires scalable and cost-effective implementation approaches. The I'm Ready programme is a national, mail-based HIVST initiative targeting key high-risk populations supplemented by peer navigation supports to enhance engagement. This study aimed to explore the cost-effectiveness of the I'm Ready programme from the perspective of Canada's publicly funded healthcare system.

Methods

We developed a Markov model to predict the lifetime costs and quality-adjusted life-years (QALYs) for high-risk individuals receiving HIVST through the I'm Ready programme compared to point-of-care testing in a physician's office (standard care). Probability and health utility values were obtained from published literature, while costs were obtained from the pilot I'm Ready programme or secondary Canadian data sources. Costs and outcomes were discounted 1.5% annually, with costs reported in 2024 Canadian dollars.

Results

At a 53% uptake, 100% HIVST sensitivity and 99.5% specificity, the I'm Ready programme was associated with an incremental cost of C$270 and a QALY gain of 0.01 per person, with an incremental cost-effectiveness ratio of $23,331/QALY compared to standard care. Key drivers of cost-effectiveness included cost and utility associated with antiretroviral therapy initiation, utility of the AIDS health state and testing uptake under standard care.

Conclusions

At the current test uptake and diagnostic accuracy levels, the I'm Ready programme is cost-effective at the willingness-to-pay threshold of $50,000 per QALY. While findings reflect the Canadian health system context, this study offers broader insight into the value of HIVST as a public health tool to accelerate progress towards global HIV awareness targets.

Abstract Image

查看原文本刊更多论文

加拿大高危人群中“我准备好了”艾滋病毒自我检测项目的成本效益。

导言：虽然HIV自我检测（HIV self-testing， HIV自检）为早期HIV检测提供了一个很有希望的解决方案，但在加拿大，获得这种检测的机会仍然有限。要实现联合国提高对艾滋病毒状况认识95%的目标，需要可扩展和具有成本效益的实施方法。“我准备好了”规划是一项以邮件为基础的全国性艾滋病毒传播倡议，针对关键高危人群，辅以同伴导航支持，以加强参与。本研究旨在从加拿大公共资助医疗保健系统的角度探讨“我准备好了”项目的成本效益。方法：我们开发了一个马尔可夫模型来预测高危人群通过I'm Ready项目接受hiv感染的终生成本和质量调整生命年（QALYs），并与在医生办公室进行的即时检测（标准治疗）进行比较。概率和健康效用值是从已发表的文献中获得的，而成本则是从“我准备好了”试点方案或加拿大二手数据源中获得的。成本和结果每年折现1.5%，成本报告以2024加元计算。结果：在53%的接受率，100%的hiv敏感性和99.5%的特异性下，I’m Ready计划与人均270加元的增量成本和0.01的QALY增益相关，与标准护理相比，增量成本-效果比为23,331美元/QALY。成本效益的主要驱动因素包括与开始抗逆转录病毒治疗有关的成本和效用、艾滋病健康状况的效用以及在标准护理下接受检测。结论：在目前的检测使用率和诊断准确性水平下，“我准备好了”项目在每个QALY 5万美元的支付意愿阈值下具有成本效益。虽然研究结果反映了加拿大卫生系统的背景，但这项研究提供了更广泛的见解，了解艾滋病毒传播作为加速实现全球艾滋病毒意识目标的公共卫生工具的价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.