@article{fdi:010085273,
  title = {{C}osts and economies of scale in repeated home-based {HIV} counselling and testing : evidence from the {ANRS} 12249 treatment as prevention trial in {S}outh {A}frica},
  author = {{B}ousmah, {M}arwan-al-{Q}ays and {I}wuji, {C}. and {O}kesola, {N}. and {O}rne-{G}liemann, {J}. and {P}illay, {D}. and {D}abis, {F}. and {L}armarange, {J}oseph and {B}oyer, {S}.},
  editor = {},
  language = {{ENG}},
  abstract = {{U}niversal {HIV} testing is now recommended in generalised {HIV} epidemic settings. {A}lthough 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}. {W}e estimated the costs of repeated {HB}-{HCT} and the scale economies that can be obtained when increasing the population coverage of the intervention. {W}e used primary data from the {ANRS} 12249 {T}reatment as {P}revention ({T}as{P}) trial in rural {S}outh {A}frica (2012-2016), whose testing component included six-monthly repeated {HB}-{HCT}. {W}e 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. {W}e 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. {T}he 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. {T}he {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. {O}ur 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. {O}verall, we showed that significant cost savings can be made from increasing population coverage. {N}evertheless, 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} ; {HIV} ; {P}revention ; {C}ost of care ; {E}conomies of scale ; {I}nterventions ; {C}linical trials ; {S}outh {A}frica ; {AFRIQUE} {DU} {SUD}},
  booktitle = {},
  journal = {{S}ocial {S}cience and {M}edicine},
  volume = {305},
  numero = {},
  pages = {115068 [10 p.]},
  ISSN = {0277-9536},
  year = {2022},
  DOI = {10.1016/j.socscimed.2022.115068},
  URL = {https://www.documentation.ird.fr/hor/fdi:010085273},
}