Background: The HPTN 071(PopART) trial is a 3-arm RCT offering a combination prevention intervention comprising annual rounds of home-based HIV testing (HBTC) delivered by Community HIV-care Providers (CHiPs) who also support linkage to care, ART retention and other HIV-related services in 21 communities in Zambia and South Africa. In Zambia, 8 communities received the CHiPs community wide intervention. We estimated total and community-specific unit costs over two rounds of the intervention.
Methods: We applied micro-costing methods to estimate the economic costs of HBTC delivered to over 250,000 individuals between December 2013 and December 2016. Total costs, cost per person tested, and cost per person tested positive were calculated. Data on salaries, equipment, supplies, transport, and general administration were extracted from program records, and merged with outcome indicators from program data. Probabilistic sensitivity analysis (PSA) by random sampling from specified distributions was conducted to determine the sensitivity of estimates to uncertainty in cost components. Costs are presented as means and standard deviations from the PSA simulations.
Results: In the first round, 126,208 individuals were tested, and among those 9,196 (7%) tested HIV-positive. In the second round, 136,966 individuals were tested and among those 4,921 (3.6%) tested HIV-positive. Costs by rounds are presented in Table 1.

 Round 1Round 2
Total economic costsUS$ 3.37mn (SD=110,911)US$ 3.40mn (SD=125,450)
Average cost per populationUS$ 7.61 (SD=0.25)US$ 7.67 (SD=0.28)
Cost per person testedUS$ 26.77 (SD=0.89)US$ 25.42 (SD=0.94)
Cost per person tested HIV-positiveUS$ 367.00 (SD=12.06)US$ 691.88 (SD=25.49)
[Table 1: Costs of home-based HIV testing and counselling by rounds]

The costs per person tested (round1: min=US$ 22.00, max=US$ 42.11, round2: min=US$ 20.30, max=US$ 36.28) did vary across communities and rounds. The costs per person tested positive (round1: min=US$ 252.29, max=US$ 751.99, round2: min=US$ 538.66, max=US$ 1,087.69) varied substantially across communities and increased between rounds.
Conclusions: The findings suggest that costs are sensitive to community-specific factors related to service delivery or population characteristics. The cost per person tested HIV-positive nearly doubled between rounds, which is partly explained by a reduction in the number of persons tested HIV-positive in the second round. The costs of HBTC can be compared with standard healthcare facility-based testing, to inform policymakers on the merit of intensified testing and counselling campaigns in high-prevalence settings. Further analysis is required to evaluate the cost-effectiveness of HBTC in terms of their wider health and non-health benefits.

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