Table 2 Summary of HTS cost studies undertaken in sub-Saharan Africa between 2006–2020 (N = 65)
From: Costs of HIV testing services in sub-Saharan Africa: a systematic literature review
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) | |