The costs of scaling up HIV and syphilis testing in low- and middle-income countries: a systematic review.
Scales
costs
healthcare costs
review
Journal
Health policy and planning
ISSN: 1460-2237
Titre abrégé: Health Policy Plan
Pays: England
ID NLM: 8610614
Informations de publication
Date de publication:
25 Jun 2021
25 Jun 2021
Historique:
accepted:
24
02
2021
pubmed:
12
3
2021
medline:
29
7
2021
entrez:
11
3
2021
Statut:
ppublish
Résumé
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 = 17) and most explored the costs of rapid HIV in facilities targeted the general population (N = 19). Only two studies focused on syphilis testing. Seventeen studies were cost analyses, 17 were cost-effectiveness analyses and 1 was cost-benefit analysis of HIV or syphilis testing. Most studies took a modelling approach (N = 25) 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 'true' 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.
Identifiants
pubmed: 33693731
pii: 6163122
doi: 10.1093/heapol/czab030
pmc: PMC8227996
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Pagination
939-954Subventions
Organisme : Medical Research Council
ID : MR/T038837/1
Pays : United Kingdom
Organisme : University of New South Wales
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
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