@article{fdi:010082052, title = {{C}osts and scale-up costs of integrating {HIV} self-testing into civil society organisation-led programmes for key populations in {C}ote d'{I}voire, {S}enegal, and {M}ali}, author = {d'{E}lbee, {M}. and {T}raore, {M}. {M}. and {B}adiane, {K}. and {V}autier, {A}. and {S}imo {F}otso, {A}rlette and {K}abemba, {O}. {K}. and {R}ouveau, {N}icolas and {G}odfrey-{F}aussett, {P}. and {M}aheu-{G}iroux, {M}. and {B}oily, {M}. {C}. and {M}edley, {G}. {F}. and {L}armarange, {J}oseph and {T}erris-{P}restholt, {F}. and {ATLAS} {T}eam,}, editor = {}, language = {{ENG}}, abstract = {{D}espite significant progress on the proportion of individuals who know their {HIV} status in 2020, {C}ote d'{I}voire (76%), {S}enegal (78%), and {M}ali (48%) remain far below, and key populations ({KP}) including female sex workers ({FSW}), men who have sex with men ({MSM}), and people who use drugs ({PWUD}) are the most vulnerable groups with a {HIV} prevalence at 5-30%. {HIV} self-testing ({HIVST}), a process where a person collects his/her own specimen, performs a test, and interprets the result, was introduced in 2019 as a new testing modality through the {ATLAS} project coordinated by the international partner organisation {S}olthis ({IPO}). {W}e estimate the costs of implementing {HIVST} through 23 civil society organisations ({CSO})-led models for {KP} in {C}ote d'{I}voire ({N} = 7), {S}enegal ({N} = 11), and {M}ali ({N} = 5). {W}e modelled costs for programme transition (2021) and early scale-up (2022-2023). {B}etween {J}uly 2019 and {S}eptember 2020, a total of 51,028, 14,472, and 34,353 {HIVST} kits were distributed in {C}ote d'{I}voire, {S}enegal, and {M}ali, respectively. {A}cross countries, 64-80% of {HIVST} kits were distributed to {FSW}, 20-31% to {MSM}, and 5-8% to {PWUD}. {A}verage costs per {HIVST} kit distributed were $15 for {FSW} ({C}ote d'{I}voire: $13, {S}enegal: $17, {M}ali: $16), $23 for {MSM} ({C}ote d'{I}voire: $15, {S}enegal: $27, {M}ali: $28), and $80 for {PWUD} ({C}ote d'{I}voire: $16, {S}enegal: $144), driven by personnel costs (47-78% of total costs), and {HIVST} kits costs (2-20%). {A}verage costs at scale-up were $11 for {FSW} ({C}ote d'{I}voire: $9, {S}enegal: $13, {M}ali: $10), $16 for {MSM} ({C}ote d'{I}voire: $9, {S}enegal: $23, {M}ali: $17), and $32 for {PWUD} ({C}ote d'{I}voire: $14, {S}enegal: $50). {C}ost reductions were mainly explained by the spreading of {IPO} costs over higher {HIVST} distribution volumes and progressive {IPO} withdrawal at scale-up. {I}n all countries, {CSO}-led {HIVST} kit provision to {KP} showed relatively high costs during the study period related to the progressive integration of the programme to {CSO} activities and contextual challenges ({COVID}-19 pandemic, country safety concerns). {I}n transition to scale-up and integration of the {HIVST} programme into {CSO} activities, this model shows large potential for substantial economies of scale. {F}urther research will assess the overall cost-effectiveness of this model.}, keywords = {costs and cost analysis ; scale-up ; {HIV} self-testing ; key populations ; knowledge of {HIV} status ; diagnosis ; screening ; {W}est {A}frica ; {COTE} {D}'{IVOIRE} ; {SENEGAL} ; {MALI}}, booktitle = {}, journal = {{F}rontiers in {P}ublic {H}ealth}, volume = {9}, numero = {}, pages = {653612 [13 ]}, year = {2021}, DOI = {10.3389/fpubh.2021.653612}, URL = {https://www.documentation.ird.fr/hor/fdi:010082052}, }