HIV self-testing (HIVST) has been found to be effective and is currently undergoing scale-up in sub-Saharan Africa. The authors were interested in the cost-effectiveness of adding HIVST to existing facility-based HIV testing and counselling (HTC) services. They developed a microsimulation model that evaluated cost-effectiveness, from both health provider and societal perspectives, of an HIVST service implemented in a cluster-randomised trial (CRT) in Malawi. They found that from the health provider perspective with a 20-year time horizon, facility HTC using 2010 WHO ART guidelines (initiate at CD4 <350 cells/μL) was the least costly (US$294.71 per person) and least effective (11.64 QALYs per person) strategy. Compared to this strategy, the incremental cost-effectiveness ratio (ICER) for facility HTC using 2015 WHO ART guidelines was US$226.85 per quality-adjusted life year (QALY) gained. The strategy of facility HTC plus HIVST (2010 WHO ART guidelines) was extendedly dominated. The ICER for facility HTC plus HIVST (2015 WHO ART guidelines) was US$253.90 per QALY gained compared with facility HTC and using 2015 WHO ART guidelines. Therefore HIVST may be cost-effective in a Malawian population with high HIV prevalence when used as part of an early HIV diagnosis and treatment strategy.
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