{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T04:39:43Z","timestamp":1768538383286,"version":"3.49.0"},"reference-count":81,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,3,9]],"date-time":"2021-03-09T00:00:00Z","timestamp":1615248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001773","name":"University of New South Wales","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001773","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Around two-thirds of all new HIV infections and 90% of syphilis cases occur in low- and middle-income countries (LMICs). Testing is a key strategy for the prevention and treatment of HIV and syphilis. Decision-makers in LMICs face considerable uncertainties about the costs of scaling up HIV and syphilis testing. This paper synthesizes economic evidence on the costs of scaling up HIV and syphilis testing interventions in LMICs and evidence on how costs change with the scale of delivery. We systematically searched multiple databases (Medline, Econlit, Embase, EMCARE, CINAHL, Global Health and the NHS Economic Evaluation Database) for peer-reviewed studies examining the costs of scaling up HIV and syphilis testing in LMICs. Thirty-five eligible studies were identified from 4869 unique citations. Most studies were conducted in Sub-Saharan Africa (N\u2009=\u200917) and most explored the costs of rapid HIV in facilities targeted the general population (N\u2009=\u200919). Only two studies focused on syphilis testing. Seventeen studies were cost analyses, 17 were cost-effectiveness analyses and 1 was cost\u2013benefit analysis of HIV or syphilis testing. Most studies took a modelling approach (N\u2009=\u200925) and assumed costs increased linearly with scale. Ten studies examined cost efficiencies associated with scale, most reporting short-run economies of scale. Important drivers of the costs of scaling up included testing uptake and the price of test kits. The \u2018true\u2019 cost of scaling up testing is likely to be masked by the use of short-term decision frameworks, linear unit-cost projections (i.e. multiplying an average cost by a factor reflecting activity at a larger scale) and availability of health system capacity and infrastructure to supervise and support scale up. Cost data need to be routinely collected alongside other monitoring indicators as HIV and syphilis testing continues to be scaled up in LMICs.<\/jats:p>","DOI":"10.1093\/heapol\/czab030","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T17:44:50Z","timestamp":1614275090000},"page":"939-954","source":"Crossref","is-referenced-by-count":15,"title":["The costs of scaling up HIV and syphilis testing in low- and middle-income countries: a systematic review"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4792-2518","authenticated-orcid":false,"given":"Rabiah al","family":"Adawiyah","sequence":"first","affiliation":[{"name":"The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga P M","family":"Saweri","sequence":"additional","affiliation":[{"name":"The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia"},{"name":"Population Health and Demography, Papua New Guinea Institute of Medical Research, PO Box 60 Homate Street, Goroka, Papua New Guinea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C","family":"Boettiger","sequence":"additional","affiliation":[{"name":"The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya L","family":"Applegate","sequence":"additional","affiliation":[{"name":"The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ari","family":"Probandari","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A. Surakarta, 57126, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Guy","sequence":"additional","affiliation":[{"name":"The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorna","family":"Guinness","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK"},{"name":"Centre for Global DevelopmentEurope, Great Peter House, Great College St, London SW1P 3SE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginia","family":"Wiseman","sequence":"additional","affiliation":[{"name":"The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia"},{"name":"London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,3,9]]},"reference":[{"key":"2021062510385809100_czab030-B1","author":"Ahaibwe","year":"2013"},{"key":"2021062510385809100_czab030-B2","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.socscimed.2018.05.048","article-title":"Why do people living with HIV not initiate treatment? 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