{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T14:35:57Z","timestamp":1777300557022,"version":"3.51.4"},"reference-count":53,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>While HIV self\u2010testing (HIVST) presents a promising solution for early HIV detection, access to such testing remains limited in Canada. Achieving the United Nations 95% target for HIV status awareness requires scalable and cost\u2010effective implementation approaches. The I'm Ready programme is a national, mail\u2010based HIVST initiative targeting key high\u2010risk populations supplemented by peer navigation supports to enhance engagement. This study aimed to explore the cost\u2010effectiveness of the I'm Ready programme from the perspective of Canada's publicly funded healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a Markov model to predict the lifetime costs and quality\u2010adjusted life\u2010years (QALYs) for high\u2010risk individuals receiving HIVST through the I'm Ready programme compared to point\u2010of\u2010care testing in a physician's office (standard care). Probability and health utility values were obtained from published literature, while costs were obtained from the pilot I'm Ready programme or secondary Canadian data sources. Costs and outcomes were discounted 1.5% annually, with costs reported in 2024 Canadian dollars.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At a 53% uptake, 100% HIVST sensitivity and 99.5% specificity, the I'm Ready programme was associated with an incremental cost of C$270 and a QALY gain of 0.01 per person, with an incremental cost\u2010effectiveness ratio of $23,331\/QALY compared to standard care. Key drivers of cost\u2010effectiveness included cost and utility associated with antiretroviral therapy initiation, utility of the AIDS health state and testing uptake under standard care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>At the current test uptake and diagnostic accuracy levels, the I'm Ready programme is cost\u2010effective at the willingness\u2010to\u2010pay threshold of $50,000 per QALY. While findings reflect the Canadian health system context, this study offers broader insight into the value of HIVST as a public health tool to accelerate progress towards global HIV awareness targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.70097","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T08:55:36Z","timestamp":1775552136000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness of the I'm Ready HIV Self\u2010Testing Programme Among High\u2010Risk Populations in Canada"],"prefix":"10.1002","volume":"29","author":[{"given":"Lisa","family":"Masucci","sequence":"first","affiliation":[{"name":"Ottawa Hospital Research Institute The Ottawa Hospital  Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hawre","family":"Jalal","sequence":"additional","affiliation":[{"name":"School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean B.","family":"Rourke","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions Unity Health Toronto (St. Michael's Hospital)  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"McBain","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions Unity Health Toronto (St. Michael's Hospital)  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8398-7239","authenticated-orcid":false,"given":"Min","family":"Xi","sequence":"additional","affiliation":[{"name":"University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Faculty of Pharmaceutical Sciences University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai V.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Memorial University  St. John's, Newfoundland Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William W. 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