Horizon 1 1 17 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES Journal of the International Aids Society e26334 [12 p.] community-led delivery cost function cost-effectiveness HIV testing services HIV-self testing key population COTE D'IVOIRE MALI SENEGAL 2024 fdi:010091133 ENG Journal of the International Aids Society ISI:001273015400001 7 10.1002/jia2.26334 https://www.documentation.ird.fr/hor/fdi:010091133 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2024-09/010091133.pdf 27 Horizon (IRD) IntroductionHIV self-testing (HIVST) is a promising strategy to improve diagnosis coverage among key populations (KP). The ATLAS (Auto Test VIH, Libre d'Acc & eacute;der & agrave; la connaissance de son Statut) programme implemented HIVST in three West African 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. We aim to evaluate the cost-effectiveness of community-led HIVST in C & ocirc;te d'Ivoire, Mali and Senegal.MethodsAn HIV transmission dynamics model was adapted and calibrated to country-specific epidemiological data and used to predict the impact of HIVST. We 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. We compared the cost-effectiveness of two scenarios against a counterfactual without HIVST over a 20-year horizon (2019-2039). The 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. The primary outcome is the number of disability-adjusted life-years (DALY) averted. Scenarios were compared using incremental cost-effectiveness ratios (ICERs). Costing was performed using a healthcare provider's perspective. Costs were discounted at 4%, converted to $USD 2022 and estimated using a cost-function to accommodate economies of scale.ResultsThe ATLAS-only scenario was highly cost-effective over 20 years, even at low willingness-to-pay thresholds. The median ICERs were $126 ($88-$210) per DALY averted in C & ocirc;te d'Ivoire, $92 ($88-$210) in Mali and 27$ ($88-$210) in Senegal. Scaling-up the ATLAS programme would also be cost-effective, and substantial epidemiological impacts would be achieved. The ICERs for the scale-up scenario were $199 ($122-$338) per DALY averted in C & ocirc;te d'Ivoire, $224 ($118-$415) in Mali and $61 ($18-$128) in Senegal.ConclusionsBoth the implemented and the potential scale-up of community-led HIVST programmes in West Africa, where KP are important to overall transmission dynamics, have the potential to be highly cost-effective, as compared to a scenario without HIVST. These findings support the scale-up of community-led HIVST to reach populations that otherwise may not access conventional testing services. 056 ; 052 UR196 / UR233