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Reaching Absent and Refusing Individuals During Home-Based HIV Testing Through Self-Testing—at What Cost?

  • Amstutz, Alain1, 2, 3
  • Matsela, Lineo4
  • Lejone, Thabo Ishmael5
  • Kopo, Mathebe5
  • Glass, Tracy Renée1, 2
  • Labhardt, Niklaus Daniel1, 2, 3
  • 1 Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel , (Switzerland)
  • 2 University of Basel, Basel , (Switzerland)
  • 3 Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel , (Switzerland)
  • 4 Health Economics Unit, Faculty of Health Sciences, University of Cape Town, Cape Town , (South Africa)
  • 5 SolidarMed, Partnerships for Health, Butha-Buthe , (Lesotho)
Published Article
Frontiers in Medicine
Frontiers Media SA
Publication Date
Jun 29, 2021
DOI: 10.3389/fmed.2021.653677
  • Medicine
  • Brief Research Report


Introduction: In the HOSENG trial (NCT03598686), the secondary distribution of oral self-tests for persons absent or refusing to test during a home-based HIV testing campaign in rural Lesotho resulted in an increase in testing coverage of 21% compared to a testing campaign without secondary distribution. This study aims to determine the per patient costs of both HOSENG trial arms. Method: We conducted a micro-costing study to estimate the cost of home-based HIV testing with (HOSENG intervention arm) and without (HOSENG control arm) secondary self-test distribution from a provider's perspective. A mixture of top-down and bottom-up costing was used. We estimated both the financial and economic per patient costs of each possible testing cascade scenario. The costs were adjusted to 2018 US$. Results: The overall provider cost for delivering the home-based HIV testing with secondary distribution was US$36,481 among the 4,174 persons enumerated and 3,094 eligible for testing in the intervention villages compared to US$28,620 for 3,642 persons enumerated and 2,727 eligible for testing in the control. The cost per person eligible for testing was US$11.79 in the intervention vs. US$10.50 in the control. This difference was mainly driven by the cost of distributed oral self-tests. The cost per person tested was, however, lower in intervention villages (US$15.70 vs. US$22.15) due to the higher testing coverage achieved through self-test distribution. The cost per person confirmed new HIV+ was US$889.79 in the intervention and US$753.17 in the control. Conclusion: During home-based HIV testing in Lesotho, the secondary distribution of self-tests for persons absent or refusing to test during the visit reduced the costs per person tested and thus presents a promising add-on for such campaigns. Trial Registration:, identifier: NCT03598686

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