@article{fdi:010091133,
  title = {{C}ost-effectiveness analysis of community-led {HIV} self-testing among key populations in {C}{\^o}te d'{I}voire, {M}ali, and {S}enegal},
  author = {{L}u, {I}. {J}. and {S}ilhol, {R}. and d'{E}lb{\'e}e, {M}. and {B}oily, {M}. {C}. and {S}oni, {N}. and {K}y-{Z}erbo, {O}. and {V}autier, {A}. and {F}osto, {A}. {S}. and {B}adiane, {K}. and {T}raor{\'e}, {M}. and {T}erris-{P}restholt, {F}. and {L}armarange, {J}oseph and {M}aheu-{G}iroux, {M}. and {A}tlas {T}eam},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction{HIV} self-testing ({HIVST}) is a promising strategy to improve diagnosis coverage among key populations ({KP}). {T}he {ATLAS} ({A}uto {T}est {VIH}, {L}ibre d'{A}cc & eacute;der & agrave; la connaissance de son {S}tatut) programme implemented {HIVST} in three {W}est {A}frican countries, distributing over 380,000 kits up between 2019 and 2021, focussing on community-led distribution by {KP} to their peers and subsequent secondary distribution to their partners and clients. {W}e aim to evaluate the cost-effectiveness of community-led {HIVST} in {C} & ocirc;te d'{I}voire, {M}ali and {S}enegal.{M}ethods{A}n {HIV} transmission dynamics model was adapted and calibrated to country-specific epidemiological data and used to predict the impact of {HIVST}. {W}e considered the distribution of {HIVST} among two {KP}-female sex workers ({FSW}), and men who have sex with men ({MSM})-and their sexual partners and clients. {W}e compared the cost-effectiveness of two scenarios against a counterfactual without {HIVST} over a 20-year horizon (2019-2039). {T}he {ATLAS}-only scenario mimicked the 2-year implemented {ATLAS} programme, whereas the {ATLAS}-scale-up scenario achieved 95% coverage of {HIVST} distribution among {FSW} and {MSM} by 2025 onwards. {T}he primary outcome is the number of disability-adjusted life-years ({DALY}) averted. {S}cenarios were compared using incremental cost-effectiveness ratios ({ICER}s). {C}osting was performed using a healthcare provider's perspective. {C}osts were discounted at 4%, converted to ${USD} 2022 and estimated using a cost-function to accommodate economies of scale.{R}esults{T}he {ATLAS}-only scenario was highly cost-effective over 20 years, even at low willingness-to-pay thresholds. {T}he median {ICER}s were $126 ($88-$210) per {DALY} averted in {C} & ocirc;te d'{I}voire, $92 ($88-$210) in {M}ali and 27$ ($88-$210) in {S}enegal. {S}caling-up the {ATLAS} programme would also be cost-effective, and substantial epidemiological impacts would be achieved. {T}he {ICER}s for the scale-up scenario were $199 ($122-$338) per {DALY} averted in {C} & ocirc;te d'{I}voire, $224 ($118-$415) in {M}ali and $61 ($18-$128) in {S}enegal.{C}onclusions{B}oth the implemented and the potential scale-up of community-led {HIVST} programmes in {W}est {A}frica, where {KP} are important to overall transmission dynamics, have the potential to be highly cost-effective, as compared to a scenario without {HIVST}. {T}hese findings support the scale-up of community-led {HIVST} to reach populations that otherwise may not access conventional testing services.},
  keywords = {community-led delivery ; cost function ; cost-effectiveness ; {HIV} testing ; services ; {HIV}-self testing ; key population ; {COTE} {D}'{IVOIRE} ; {MALI} ; {SENEGAL}},
  booktitle = {},
  journal = {{J}ournal of the {I}nternational {A}ids {S}ociety},
  volume = {27},
  numero = {7},
  pages = {e26334 [12 p.]},
  year = {2024},
  DOI = {10.1002/jia2.26334},
  URL = {https://www.documentation.ird.fr/hor/fdi:010091133},
}