PMID- 36709657 OWN - NLM STAT- MEDLINE DCOM- 20230307 LR - 20240302 IS - 2212-1102 (Electronic) IS - 2212-1099 (Print) IS - 2212-1099 (Linking) VI - 34 DP - 2023 Mar TI - Cost of Home-Based Couples Human Immunodeficiency Virus Counseling and Testing and Human Immunodeficiency Virus Self-Testing During Pregnancy and Postpartum in Southwestern Kenya. PG - 125-132 LID - S2212-1099(22)00205-9 [pii] LID - 10.1016/j.vhri.2022.11.003 [doi] AB - OBJECTIVE: Home-based couples HIV testing and counseling and HIV self-testing (HIVST) for pregnant women can promote HIV status disclosure and male partner testing; however, cost data are lacking. We examined a home-based couples intervention (HBCI) and HIVST intervention costs per couple (unit cost) during pregnancy and postpartum in Kenya. METHODS: This randomized controlled trial is comparing HBCI and HIVST for couples among pregnant women attending antenatal care clinics in two counties in southwestern Kenya. We used micro-costing to estimate the unit cost per couple receiving the intervention as the total of direct and indirect costs for each study arm in 2019 US$. We used a one-month window to conduct a time and motion study to determine personnel effort and resources. We then compared the unit cost by arm, identified key cost drivers, and conducted sensitivity analyses for cost uncertainties. RESULTS: At base-case, the unit cost was $129.01 and $41.99, respectively, for HBCI and HIVST. Personnel comprised half of the unit cost for both arms. Staff spent more time on activities related to participant engagement in HBCI (accounting for 6.4% of the unit cost) than in HIVST (2.3%). Staff training was another key cost driver in HBCI (20.1% of the unit cost compared to 12.5% in HIVST). Sensitivity analyses revealed that the unit cost ranges were $104.64-$154.54 for HBCI and $30.49-$56.59 for HIVST. CONCLUSIONS: Our findings may guide spending decisions for future HIV prevention and treatment programs for pregnant couples in resource-limited settings such as Kenya. CI - Copyright (c) 2022 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved. FAU - Borgstede, Seth J AU - Borgstede SJ AD - Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Elly, Assurah AU - Elly A AD - Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya. FAU - Helova, Anna AU - Helova A AD - Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; Sparkman Center for Global Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Kwena, Zachary AU - Kwena Z AD - Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya. FAU - Darbes, Lynae A AU - Darbes LA AD - Center for Sexuality and Health Disparities, and Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA. FAU - Hatcher, Abigail AU - Hatcher A AD - Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. FAU - Thirumurthy, Harsha AU - Thirumurthy H AD - Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. FAU - Owino, George AU - Owino G AD - Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya. FAU - Pisu, Maria AU - Pisu M AD - Department of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Owuor, Kevin AU - Owuor K AD - Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Braun, Thomas AU - Braun T AD - Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA. FAU - Turan, Janet M AU - Turan JM AD - Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; Sparkman Center for Global Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Bukusi, Elizabeth A AU - Bukusi EA AD - Research, Care and Treatment Programme, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya. FAU - Nghiem, Van T AU - Nghiem VT AD - Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: nghiem@uab.edu. LA - eng GR - P30 AI027767/AI/NIAID NIH HHS/United States GR - R01 MH116736/MH/NIMH NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial DEP - 20230127 PL - United States TA - Value Health Reg Issues JT - Value in health regional issues JID - 101592642 SB - IM MH - Humans MH - Male MH - Female MH - Pregnancy MH - *Self-Testing MH - Kenya MH - *HIV Infections/prevention & control MH - Postpartum Period MH - Counseling MH - HIV Testing MH - HIV PMC - PMC9992305 MID - NIHMS1859061 OTO - NOTNLM OT - HIV OT - HIV testing OT - Kenya OT - costs OT - counseling OT - couples therapy OT - home care services OT - mother-to-child transmission OT - self-testing COIS- Conflict of interest Disclosure: The authors reported no conflicts of interest. EDAT- 2023/01/30 06:00 MHDA- 2023/03/08 06:00 PMCR- 2024/03/01 CRDT- 2023/01/29 18:14 PHST- 2022/07/01 00:00 [received] PHST- 2022/11/05 00:00 [revised] PHST- 2022/11/30 00:00 [accepted] PHST- 2023/01/30 06:00 [pubmed] PHST- 2023/03/08 06:00 [medline] PHST- 2023/01/29 18:14 [entrez] PHST- 2024/03/01 00:00 [pmc-release] AID - S2212-1099(22)00205-9 [pii] AID - 10.1016/j.vhri.2022.11.003 [doi] PST - ppublish SO - Value Health Reg Issues. 2023 Mar;34:125-132. doi: 10.1016/j.vhri.2022.11.003. Epub 2023 Jan 27.