Economic costs and health-related quality of life outcomes of HIV treatment following self- and facility-based HIV testing in a cluster randomised trial

Background HIV self-testing (HIVST) is recommended in Africa, but little is known about how this approach influences economic outcomes following subsequent antiretroviral treatment (ART) compared to facility-based HIV testing and counselling (HTC). Methods HIV-positive participants attending HIV clinics, diagnosed by HIVST or facility-based HTC as part of a community cluster-randomised trial (ISRCTN02004005), were followed from initial assessment for ART until one-year postinitiation. Healthcare resource use was measured, and costing studies estimated total health provider costs. Participants were interviewed to establish direct non-medical and indirect costs over the first-year of ART. Costs were adjusted to 2014 US$ and INT$. Health-related quality of life was measured using EuroQol EQ-5D. Multivariable analyses estimated predictors of economic outcomes. Results Of 325 participants attending HIV clinics for assessment for ART, 265 were identified through facility-based HTC, and 60 through HIVST; 168/265 (69.2%) and 36/60 (60.0%), respectively, initiated ART. Mean total health provider assessment costs for ART initiation were US$22.79 (SE:0.56) and US$19.92 (SE:0.77) for facilitybased HTC and HIVST participants, respectively, and was US$2.87 (bootstrap95%CI:US$1.01,US$4.73) lower for the HIVST group. Mean health provider costs for first-year of ART were US$168.65 (SE:2.02) and US$164.66 (SE:4.21) for facility-based HTC and HIVST participants, respectively, and were comparable (bootstrap95%CI:-US$12.38,US$4.39). EQ-5D utility scores were comparable between the two groups, and one-year after ART initiation had increased by 0.129 (SE:0.011) and 0.139 (SE:0.027) for facility-based HTC and HIVST participants, respectively. Conclusions Once HIV self-testers are linked into HIV services, their economic outcomes are comparable to those linking to services after facility-based HTC