{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:12:08Z","timestamp":1791882728737,"version":"4.3.4"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Malawi is rapidly closing the gap in achieving the UNAIDS 95\u201095\u201095 targets, with 90% of people living with HIV in Malawi aware of their status. As we approach epidemic control, interventions to improve coverage will become more costly. There is, therefore, an urgent need to identify innovative and low\u2010cost strategies to maintain and increase testing coverage without diverting resources from other HIV services. The objective of this study is to model different combinations of facility\u2010based HIV testing modalities and determine the most cost\u2010effective strategy to increase the proportion of men and youth testing for HIV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A data\u2010driven individual\u2010based model was parameterized with data from a community\u2010representative survey (socio\u2010demographic, health service utilization and HIV testing history) of men and youth in Malawi (data collected August 2019). In total, 79 different strategies for the implementation of HIV self\u2010testing (HIVST) and provider\u2010initiated\u2010testing\u2010and\u2010counselling at the outpatient department (OPD) were evaluated. Outcomes included percent of men\/youth tested for HIV in a 12\u2010month period, cost\u2010effectiveness and human resource requirements. The testing yield was assumed to be constant across the scenarios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Facility\u2010based HIVST offered year\u2010round resulted in the greatest increase in the proportion of men and youth tested in the OPD (from 45% to 72%\u201383%), was considered cost\u2010saving for HIVST kit priced at $1.00, and generally reduced required personnel as compared to the status quo. At higher HIVST kit prices, and more relaxed eligibility criteria, all scenarios that considered year\u2010round HIVST in the OPD remained on the cost\u2010effectiveness frontier.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Facility\u2010based HIVST is a cost\u2010effective strategy to increase the proportion of men\/youth tested for HIV in Malawi and decreases the human resource requirements for HIV testing in the OPD\u2014providing additional healthcare worker time for other priority healthcare activities.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26020","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T15:22:16Z","timestamp":1666020136000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Facility\u2010based HIV self\u2010testing strategies may substantially and cost\u2010effectively increase the number of men and youth tested for HIV in Malawi: results from an individual\u2010based mathematical model"],"prefix":"10.1002","volume":"25","author":[{"given":"Brooke E.","family":"Nichols","sequence":"first","affiliation":[{"name":"Department of Global Health, School of Public Health Boston University  Boston Massachusetts USA"},{"name":"Health Economics and Epidemiology Research Office, Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand  Johannesburg South Africa"},{"name":"Department of Medical Microbiology Amsterdam University Medical Centre  Amsterdam the Netherlands"},{"name":"Foundation for Innovative New Diagnostics  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"de Nooy","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology Amsterdam University Medical Centre  Amsterdam the Netherlands"},{"name":"Right to Care  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariet","family":"Benade","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health Boston University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Balakasi","sequence":"additional","affiliation":[{"name":"Partners in Hope  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misheck","family":"Mphande","sequence":"additional","affiliation":[{"name":"Partners in Hope  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Rao","sequence":"additional","affiliation":[{"name":"Tufts University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassidy W.","family":"Claassen","sequence":"additional","affiliation":[{"name":"Center for International Health, Education, and Biosecurity University of Maryland School of Medicine  Baltimore Maryland USA"},{"name":"Division of Infectious Diseases, Department of Medicine University of Zambia School of Medicine  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7247-4190","authenticated-orcid":false,"given":"Shaukat","family":"Khan","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative  Boston Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Stillson","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative  Boston Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin A.","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Global Health, School of Public Health Boston University  Boston Massachusetts USA"},{"name":"Department of Medical Microbiology Amsterdam University Medical Centre  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoko","family":"Doi","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative  Boston Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5622-3401","authenticated-orcid":false,"given":"Kathryn","family":"Dovel","sequence":"additional","affiliation":[{"name":"Right to Care  Johannesburg South Africa"},{"name":"Division of Infectious Diseases, Department of Medicine University of California Los Angeles David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"UNAIDS (Joint United Nations Programme on HIV\/AIDS).UNAIDS data 2019.Geneva;2019."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0248410"},{"key":"e_1_2_11_4_1","unstructured":"Ministry of Health Centers for Disease Control and Prevention (U.S.).Malawi Population\u2010Based HIV Impact Assessment (MPHIA) 2015\u201316\u202f: first report.2017[cited 2022 Jul 12]. 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In:Conference on Retroviruses and Opportunistic Infections (CROI).Seattle;2019."},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-016-0577-7"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001873"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-12213-6"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26020","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.26020","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T08:48:52Z","timestamp":1692607732000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":22,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1002\/jia2.26020"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26020","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10]]},"assertion":[{"value":"2022-03-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26020"}}