Costs and economies of scale in repeated home-based HIV counselling and testing: Evidence from the ANRS 12249 treatment as prevention trial in South Africa

Marwân-al-Qays Bousmah (), Collins Iwuji, Nonhlanhla Okesola, Joanna Orne-Gliemann, Deenan Pillay, Francois Dabis, Joseph Larmarange () and Sylvie Boyer
Additional contact information
Collins Iwuji: University of Sussex
Nonhlanhla Okesola: AHRI - Africa Health Research Institute [KwaZulu-Natal]
Joanna Orne-Gliemann: BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale, GHiGS - Global Health in the Global South - IRD - Institut de Recherche pour le Développement - BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale
Deenan Pillay: UCL - University College of London [London]
Francois Dabis: BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale, GHiGS - Global Health in the Global South - IRD - Institut de Recherche pour le Développement - BPH - Bordeaux population health - UB - Université de Bordeaux - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - INSERM - Institut National de la Santé et de la Recherche Médicale
Joseph Larmarange: CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPCité - Université Paris Cité, IRD - Institut de Recherche pour le Développement, SAGESUD - ERL Inserm U1244 - Santé, vulnérabilités et relations de genre au sud - INSERM - Institut National de la Santé et de la Recherche Médicale - CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPCité - Université Paris Cité
Sylvie Boyer: SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale, ISSPAM - Institut des sciences de la santé publique [Marseille]

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Abstract: Universal HIV testing is now recommended in generalised HIV epidemic settings. Although home-based HIV counselling and testing (HB-HCT) has been shown to be effective in achieving high levels of HIV status awareness, little is still known about the cost implications of universal and repeated HB-HCT. We estimated the costs of repeated HB-HCT and the scale economies that can be obtained when increasing the population coverage of the intervention. We used primary data from the ANRS 12249 Treatment as Prevention (TasP) trial in rural South Africa (2012-2016), whose testing component included six-monthly repeated HB-HCT. We relied on the dynamic system generalised method of moments (GMM) approach to produce unbiased short- and long-run estimates of economies of scale, using the number of contacts made by HIV counsellors for HB-HCT as the scale variable. We also estimated the mediating effect of the contact quality - measured as the proportion of HIV tests performed among all contacts eligible for an HIV test - on scale economies. The mean cost (standard deviation) of universal and repeated HB-HCT was $24.2 (13.7) per contact, $1694.3 (1527.8) per new HIV diagnosis, and $269.2 (279.0) per appropriate referral to HIV care. The GMM estimations revealed the presence of economies of scale, with a 1% increase in the number of contacts for HB-HCT leading to a 0.27% decrease in the mean cost. Our results also suggested a significant long-run relationship between mean cost and scale, with a 1% increase in the scale leading to a 0.36% decrease in mean cost in the long run. Overall, we showed that significant cost savings can be made from increasing population coverage. Nevertheless, there is a risk that this gain is made at the expense of quality: the higher the quality of HB-HCT activities, the lower the economies of scale.

Keywords: AIDS/HIV; Prevention; Cost of care; Economies of scale; Interventions; Clinical trials; South Africa (search for similar items in EconPapers)
Date: 2022-07
New Economics Papers: this item is included in nep-eff
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Published in Social Science and Medicine, 2022, 305, pp.115068. ⟨10.1016/j.socscimed.2022.115068⟩

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Journal Article: Costs and economies of scale in repeated home-based HIV counselling and testing: Evidence from the ANRS 12249 Treatment as Prevention trial in South Africa (2022)
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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-03701276

DOI: 10.1016/j.socscimed.2022.115068

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