CONSIDERATIONS FOR COSTS. Overall evidence has shown that HIV self- testing can be cost-effective when targeted toward populations where fewer people with HIV know their status and for whom treatment coverage is low. The costs of HIVST however have generally appeared to be higher than costs of facility-based conventional provider delivered testing, and the cost of community- or home-based HIVST distribution tended to be higher than that of facility-based HIVST distribution. The incremental unit costs of community-based HIVST distribution in Zimbabwe and Zambia for example were estimated to be two and three times higher than facility based HIVST incremental costs, respectively ($14.69 vs $6.10 in Zimbabwe and $17.00 vs $5.37 in Zambia) with major cost drivers being personnel and commodity costs. EpiC HIVST OPERATIONAL GUIDE Figure 1. How HIVST can turn investments into broad health and social impacts (source: WHO, 2019) EpiC HIVST OPERATIONAL GUIDE However, there are important limitations to such comparisons, given that cost data come from different sources and settings, therefore, are not directly comparable. Especially as these costs are general program costs and do not consider opportunity costs to testers or accessibility and equity issues. HIV testing costs can vary substantially, and it is important to consider the most efficient and effective ways to distribute self-test kits and achieve impact. In addition, cost of diagnosing additional infections through standard testing services can be substantial, especially in settings with generally high testing and treatment coverage.
