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Our objective was to model the cost\u2010per\u2010HIV infection averted by CVCT in six African countries guided by an HIV prevention cascade framework. The HIV prevention cascade as yet to be applied to evaluating CVCT effectiveness or cost\u2010effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We defined a priority population for CVCT in Africa as heterosexual adults in stable couples. Based on our previous experience nationalizing CVCT in Rwanda and scaling\u2010up CVCT in 73 clinics in Zambia, we estimated HIV prevention cascade domains of motivation for use, access and effectiveness of CVCT as model parameters. Costs\u2010per\u2010couple tested were also estimated based on our previous studies. We used these parameters as well as country\u2010specific inputs to model the impact of CVCT over a five\u2010year time horizon in a previously developed and tested deterministic compartmental model. We consider six countries across Africa with varied HIV epidemics (South Africa, Zimbabwe, Kenya, Tanzania, Ivory Coast and Sierra Leone). Outcomes of interest were the proportion of HIV infections averted by CVCT, nationwide CVCT implementation costs and costs\u2010per\u2010HIV infection averted by CVCT. We applied 3%\/year discounting to costs and outcomes. Univariate and Monte Carlo multivariate sensitivity analyses were conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We estimated that CVCT could avert between 54% (Sierra Leone) and 62% (South Africa) of adult HIV infections. Average costs\u2010per\u2010HIV infection averted were lowest in Zimbabwe ($550) and highest in South Africa ($1272). Nationwide implementations would cost between 7% (Kenya) and 21% (Ivory Coast) of a country\u2019s President\u2019s Emergency Plan for AIDS Relief (PEPFAR) budget over five years. In sensitivity analyses, model outputs were most sensitive to estimates of cost\u2010per\u2010couple tested; the proportion of adults in heterosexual couples and HIV prevention cascade domains of CVCT motivation and access.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our model indicates that nationalized CVCT could prevent over half of adult HIV infections for 7% to 21% of the modelled countries\u2019 five\u2010year PEPFAR budgets. While other studies have indicated that CVCT motivation is high given locally relevant promotional and educational efforts, without required indicators, targets and dedicated budgets, access remains low.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25522","type":"journal-article","created":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T12:08:45Z","timestamp":1593518925000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Cost\u2010effectiveness of couples\u2019 voluntary HIV counselling and testing in six African countries: a modelling study guided by an HIV prevention cascade framework"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-2004","authenticated-orcid":false,"given":"Kristin M","family":"Wall","sequence":"first","affiliation":[{"name":"Rwanda Zambia HIV Research Group Department of Pathology &amp; Laboratory Medicine School of Medicine and Hubert Department of Global Health Rollins School of Public Health Laney Graduate School Emory University Atlanta GA USA"},{"name":"Department of Epidemiology Rollins School of Public Health Laney Graduate School Emory University Atlanta GA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mubiana","family":"Inambao","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group Department of Pathology &amp; 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