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Background: Long distance truck drivers (LDTD) are a high-HIV-risk population facing unique healthcare barriers due to continuous travel and irregular schedules, and may require targeted, resource-intensive strategies for HIV-test uptake. We conducted a trial-based cost-effectiveness of CHIVST among LDTD in Kenya.
Methods: Effectiveness data came from a randomized-controlled trial of CHIVST (n=150) versus provider-administered testing (n=155). Economic cost data came from the literature and reflected a societal perspective. Generalized Poisson and linear-gamma regression models estimated the effectiveness (relative-risk) and incremental costs (2017 I$), respectively, with incremental effectiveness calculated as the reciprocal of the absolute risk difference and reported as the number needing to receive CHIVST for an additional HIV-test uptake. We reported incremental cost-effectiveness ratios (ICERs), with 95%CIs calculated using Fieller’s theorem. Deterministic sensitivity analysis identified key cost drivers and cost-effectiveness acceptability curves assessed uncertainty in the ICER. We determined cost-effectiveness according to a willingness-to-pay threshold of 3xGDP per-capita of Kenya (I$9,774).
Results: HIV-test uptake was 23% more likely for CHIVST versus provider-administered HIVtesting, with six individuals needing to be offered CHIVST for an additional HIV-test uptake (6.25, 95%CI 5.00-8.33). The mean cost per patient was more than double for CHIVST (I$26.56 vs I$10.47). The incremental cost-effectiveness of CHIVST was I$97.21 [95%CI 65.74-120.98] per additional HIV-test uptake compared to provider-administered HIV-testing. Self-test kits and Page | 59 patient time were the main cost drivers of the ICER. The probability of CHIVST being costeffective approached one at a willingness-to-pay threshold of I$140.
Conclusion: CHIVST is an efficient use of resources compared to provider-administered testing.
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