{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:27:00Z","timestamp":1790141220099,"version":"4.0.1"},"reference-count":20,"publisher":"BMJ","issue":"Suppl 4","license":[{"start":{"date-parts":[[2021,7,13]],"date-time":"2021-07-13T00:00:00Z","timestamp":1626134400000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/igo\/"}],"funder":[{"name":"BMGF","award":["OPP1189095"],"award-info":[{"award-number":["OPP1189095"]}]},{"name":"Unitaid","award":["PO#8477-0-600"],"award-info":[{"award-number":["PO#8477-0-600"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2021,3,31]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Countries around the world seek innovative ways of closing their remaining gaps towards the target of 95% of people living with HIV (PLHIV) knowing their status by 2030. Offering kits allowing HIV self-testing (HIVST) in private might help close these gaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed the cost, use and linkage to onward care of 11 HIVST kit distribution models alongside the Self-Testing AfRica Initiative\u2019s distribution of 2.2 million HIVST kits in South Africa in 2018\/2019. Outcomes were based on telephonic surveys of 4% of recipients; costs on a combination of micro-costing, time-and-motion and expenditure analysis. Costs were calculated from the provider perspective in 2019 US$, as incremental costs in integrated and full costs in standalone models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HIV positivity among kit recipients was 4%\u201323%, with most models achieving 5%\u20136%. Linkage to confirmatory testing and antiretroviral therapy (ART) initiation for those screening positive was 19%\u201378% and 2%\u201372% across models. Average costs per HIVST kit distributed varied between $4.87 (sex worker model) and $18.07 (mobile integration model), with differences largely driven by kit volumes. HIVST kit costs (at $2.88 per kit) and personnel costs were the largest cost items throughout. Average costs per outcome increased along the care cascade, with the sex worker network model being the most cost-effective model across metrics used (cost per kit distributed\/recipient screening positive\/confirmed positive\/initiating ART). Cost per person confirmed positive for HIVST was higher than standard HIV testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HIV self-test distribution models in South Africa varied widely along four characteristics: distribution volume, HIV positivity, linkage to care and cost. Volume was highest in models that targeted public spaces with high footfall (flexible community, fixed point and transport hub distribution), followed by workplace models. Transport hub, workplace and sex worker models distributed kits in the least costly way. Distribution via index cases at facility as well as sex worker network distribution identified the highest number of PLHIV at lowest cost.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2021-005019","type":"journal-article","created":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T00:45:46Z","timestamp":1641516346000},"page":"e005019","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["The cost and intermediary cost-effectiveness of oral HIV self-test kit distribution across 11 distribution models in South Africa"],"prefix":"10.1136","volume":"6","author":[{"given":"Katleho","family":"Matsimela","sequence":"first","affiliation":[{"name":"Health Economics and Epidemiology Research Office (HE1RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda Alinafe","family":"Sande","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK"},{"name":"Department of HIV\/AIDS and TB, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyprian","family":"Mostert","sequence":"additional","affiliation":[{"name":"Wits Reproductive Health and HIV Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Majam","sequence":"additional","affiliation":[{"name":"Ezintsha, Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Phiri","sequence":"additional","affiliation":[{"name":"Ezintsha, Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Zishiri","sequence":"additional","affiliation":[{"name":"Ezintsha, Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste","family":"Madondo","sequence":"additional","affiliation":[{"name":"Society for Family Health, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Khama","sequence":"additional","affiliation":[{"name":"Society for Family Health, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thato","family":"Chidarikire","sequence":"additional","affiliation":[{"name":"HIV Prevention Programmes, National Department of Health, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"d'Elb\u00e9e","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Hatzold","sequence":"additional","affiliation":[{"name":"Population Services International, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Johnson","sequence":"additional","affiliation":[{"name":"HIV Department, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fern","family":"Terris-Prestholt","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK"},{"name":"Joint United Nations Programme on HIV\/AIDS, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gesine","family":"Meyer-Rath","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office (HE1RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"},{"name":"Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,7,18]]},"reference":[{"key":"2025073014335067000_6.Suppl_4.e005019.1","unstructured":"Johnson L . 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HIV self-Testing and partner notification supplement to consolidated guidelines on HIV testing services 2016."},{"key":"2025073014335067000_6.Suppl_4.e005019.6","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/s10461-019-02552-2","article-title":"Use and acceptability of HIV Self-Testing among first-time testers at risk for HIV in Senegal","volume":"23","author":"Lyons","year":"2019","journal-title":"AIDS Behav"},{"key":"2025073014335067000_6.Suppl_4.e005019.7","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2019.33.218.17242"},{"key":"2025073014335067000_6.Suppl_4.e005019.8","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1080\/09540121.2018.1503638","article-title":"Acceptability of HIV self-testing among men and women in KwaZulu-Natal, South Africa","volume":"31","author":"Harichund","year":"2019","journal-title":"AIDS Care"},{"key":"2025073014335067000_6.Suppl_4.e005019.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0202521","article-title":"Mate Yako Afya Yako: formative research to develop the Tanzania HIV self-testing education and promotion (Tanzania step) project for men","volume":"13","author":"Conserve","year":"2018","journal-title":"PLoS One"},{"key":"2025073014335067000_6.Suppl_4.e005019.10","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-40055-1"},{"key":"2025073014335067000_6.Suppl_4.e005019.11","unstructured":"Mostert C . The impact and cost of HIV Self-Test distribution in workplaces in South Africa. Abstract. Conference on Retroviruses and Opportunistic Infection, 2020."},{"key":"2025073014335067000_6.Suppl_4.e005019.12","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-016-0577-7"},{"key":"2025073014335067000_6.Suppl_4.e005019.13","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25255","article-title":"Economic cost analysis of door-to-door community-based distribution of HIV Self-Test kits in Malawi, Zambia and Zimbabwe","volume":"22(Suppl 1)","author":"Mangenah","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"2025073014335067000_6.Suppl_4.e005019.14","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1097\/QAD.0000000000002664","article-title":"Using HIV self-testing to increase the affordability of community-based HIV testing services","volume":"34","author":"d'Elb\u00e9e","year":"2020","journal-title":"AIDS"},{"key":"2025073014335067000_6.Suppl_4.e005019.15","doi-asserted-by":"crossref","first-page":"e0195208","DOI":"10.1371\/journal.pone.0195208","article-title":"Factors associated with linkage to HIV care and TB treatment at community-based HIV testing services in Cape town, South Africa","volume":"13","author":"Meehan","year":"2018","journal-title":"PLoS One"},{"key":"2025073014335067000_6.Suppl_4.e005019.16","unstructured":"Vassall A , Sweeney S , Kahn JG , et al . Reference case for estimating the costs of global health services and interventions 2017."},{"key":"2025073014335067000_6.Suppl_4.e005019.17","unstructured":"Rates - South African Reserve Bank. Available: https:\/\/www.resbank.co.za\/Research\/Rates\/Pages\/Rates-Home.aspx [Accessed 05 Oct 2020]."},{"key":"2025073014335067000_6.Suppl_4.e005019.18","unstructured":"\u201cPress Release: OraSure Technologies to Drive Accelerated Adoption of OraQuick\u00ae HIV Self-Test - Gates SIF.\u201d [Online]. Available: https:\/\/sif.gatesfoundation.org\/news-and-updates\/press-release-orasure-technologies-drive-accelerated-adoption-oraquick-hiv-self-test\/ [Accessed 05 Oct 2020]."},{"key":"2025073014335067000_6.Suppl_4.e005019.19","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001528"},{"key":"2025073014335067000_6.Suppl_4.e005019.20","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/hec.3306","article-title":"Incorporating demand and supply constraints into economic evaluations in low-income and middle-income countries","volume":"25(Suppl 1)","author":"Vassall","year":"2016","journal-title":"Health Econ"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2021-005019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T21:34:00Z","timestamp":1753911240000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2021-005019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":20,"journal-issue":{"issue":"Suppl 4","published-online":{"date-parts":[[2021,7,18]]},"published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1136\/bmjgh-2021-005019"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2021-005019","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}