Costs of accessing HIV testing services among rural Malawi communities

ABSTRACT

HIV testing is free in Malawi, but users may still incur costs that can deter or delay them accessing these services. We sought to identify and quantify these costs among HIV testing service clients in Malawi. We asked residents of communities participating in a cluster randomised trial investigating the impact of HIV self-testing about their past HIV testing experiences and the direct non-medical and indirect costs incurred to access HIV testing. We recruited 749 participants whose most recent HIV test was within the past 12 months. The mean total cost to access testing was US$2.45 (95%CI: US$2.11–US$2.70). Men incurred higher costs (US$3.81; 95%CI: US$2.91–US$4.50) than women (US$1.83; 95%CI: US$1.61–US$2.00). Results from a two-part multivariable regression analysis suggest that age, testing location, time taken to test, visiting a facility specifically for an HIV test and district of residence significantly affected the odds of incurring costs to testing. In addition, gender, wealth, age, education and district of residence were associated with significant user costs.

KEYWORDS:

• HIV
• HIV testing and counseling
• total costs

Acknowledgements

We acknowledge the participants who generously agreed to respond to the questionnaires, the entire Population Services International-Malawi research and implementation teams, researchers and data teams from the London School of Hygiene and Tropical Medicine and the Malawi-Liverpool Wellcome Trust Clinical Research Programme. The Data will be deposited to London School of Hygiene & Tropical Medicine’s digital repository (http://datacompass.lshtm.ac.uk/).

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

Abbreviations: AIDS: Acquired Immune Deficiency Syndrome; ANC: Antenatal Care; ART: AntiRetroviral Therapy; CBDA: Community-Based Distribution Agent; CBHTS: Community-Based HIV Testing Services; CRT: Cluster Randomized trial; GLM: Generalised Linear Model; HIV: Human Immunodeficiency Virus; HIVST: HIV Self-Testing; HTC: HIV Testing and Counselling; IHS: Integrated Household Survey; OLS: Ordinary Least Squares; PCA: Principal Component Analysis; PITC: Provider Initiated Testing and Counselling; PLHIV: People Living with HIV; STAR: Self-Testing AfRica; TB: Tuberculosis; TPM: Two-Part Model; UNAIDS: The Joint United Nations Programme on HIV/AIDS; VCT: Voluntary Counselling and Testing

1 Asset index: Electricity, radio, working television set, mobile phone, landline telephone, refrigerator and bed with mattress.

Additional information

Funding

This research is under Self-Testing AfRica (STAR) Project is funded by UNITAID [grant number PO#8477-0-600]. E.L.C. is funded by a Wellcome Trust Senior Research Fellowship in Clinical Science [grant number WT200901/Z/16/Z].