肯尼亚卡车司机进行 HIV 自我检测的经济成本和成本效益。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Deo Mujwara, Elizabeth A Kelvin, Bassam Dahman, Gavin George, Daniel Nixon, Tilahun Adera, Eva Mwai, April D Kimmel
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引用次数: 0

摘要

对艾滋病毒感染状况的认识对于结束艾滋病毒流行至关重要,但在艾滋病毒高危人群和难以接触到的亚人群中,对艾滋病毒感染状况的认识仍然很低。需要采取有针对性的高效干预措施来提高艾滋病检测率。我们研究了在长途卡车司机中提供自行口服 HIV 检测选择(HIVST-Choice)与仅由医疗服务提供者提供检测(护理标准(SOC))的成本效益递增。有效性数据来自在肯尼亚两个路边健康诊所进行的随机对照试验(HIVST-Choice 部分,n=150;SOC 部分,n=155)。经济成本数据来自文献,反映了社会视角,并以 2020 年国际美元(I$)为单位进行报告,国际美元是与美元具有同等购买力的假设货币。广义泊松回归模型和线性伽马回归模型分别用于估算有效性和增量成本;增量有效性以需要接受 HIVST-Choice 检测的长途卡车司机人数来报告,以增加一次 HIV 检测。我们计算了 HIVST-Choice 与 SOC 相比的增量成本效益比 (ICER),并使用非参数引导法估计了 95% 的置信区间 (CI)。使用确定性敏感性分析和成本效益可接受性曲线对不确定性进行了评估。HIVST-Choice的HIV检测接受率提高了23%,六个人需要接受HIVST-Choice才能多接受一次HIV检测。HIVST-Choice 每名患者的平均成本(39.28 美元)比 SOC(10.80 美元)高出近 4 倍,每增加一次检测的 ICER 为 174.51 美元,95% CI [165.72, 194.59]。HIV 自我检测试剂盒和手机服务成本是 ICER 的主要驱动因素,尽管即使在可能的最高成本下,研究结果也是稳健的。当每增加一次 HIV 检测的付费意愿为 200 美元时,成本效益概率接近 1。HIVST-Choice 在较低的支付意愿阈值下提高了卡车司机的 HIV 检测率,表明 HIV 自我检测是对资源的有效利用。在类似的高风险、难以接触到的亚人群中,支持艾滋病毒自我检测的政策可能会加快国际目标的实现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya.

HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of offering the choice of self-administered oral HIV-testing (HIVST-Choice) compared with provider-administered testing only [standard-of-care (SOC)] among long-distance truck drivers. Effectiveness data came from a randomized-controlled trial conducted at two roadside wellness clinics in Kenya (HIVST-Choice arm, n = 150; SOC arm, n = 155). Economic cost data came from the literature, reflected a societal perspective and were reported in 2020 international dollars (I$), a hypothetical currency with equivalent purchasing power as the US dollar. Generalized Poisson and linear gamma regression models were used to estimate effectiveness and incremental costs, respectively; incremental effectiveness was reported as the number of long-distance truck drivers needing to receive HIVST-Choice for an additional HIV test-uptake. We calculated the incremental cost-effectiveness ratio (ICER) of HIVST-Choice compared with SOC and estimated 95% confidence intervals (CIs) using non-parametric bootstrapping. Uncertainty was assessed using deterministic sensitivity analysis and the cost-effectiveness acceptability curve. HIV test-uptake was 23% more likely for HIVST-Choice, with six individuals needing to be offered HIVST-Choice for an additional HIV test-uptake. The mean per-patient cost was nearly 4-fold higher in HIVST-Choice (I$39.28) versus SOC (I$10.80), with an ICER of I$174.51, 95% CI [165.72, 194.59] for each additional test-uptake. HIV self-test kit and cell phone service costs were the main drivers of the ICER, although findings were robust even at highest possible costs. The probability of cost-effectiveness approached 1 at a willingness-to-pay of I$200 for each additional HIV test-uptake. HIVST-Choice improves HIV-test-uptake among truck drivers at low willingness-to-pay thresholds, suggesting that HIV self-testing is an efficient use of resources. Policies supporting HIV self-testing in similar high risk, hard-to-reach sub-populations may expedite achievement of international targets.

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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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