Abstract
ABSTRACTHIV 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.
Highlights
Eastern and Southern Africa account for the highest numbers of people living with Human Immunodeficiency Virus (HIV) (PLHIV), newly infected with HIV, and dying from HIV (UNAIDS, 2017)
Most of the participants (83%) reported facility-based testing as their most recent testing approach. Among those who tested in a facility, more participants (76%) accessed testing through provider-initiated testing and counseling (PITC)
Our findings indicate that the average cost of accessing HIV testing in rural Malawi is less than that reported in urban areas of the country (US$3.09 per test) (Maheswaran et al, 2016), yet rural testers incur costs that are equivalent to twice the daily minimum income required for their basic needs (National Statistics Office, 2012)
Summary
Eastern and Southern Africa account for the highest numbers of people living with HIV (PLHIV), newly infected with HIV, and dying from HIV (UNAIDS, 2017). HIV testing is an essential gateway to HIV prevention, treatment, care and support services since receipt of an HIV diagnosis empowers individuals to make informed decisions about follow on services in the cascade (World Health Organization, 2015; World Health Organization & UNAIDS, 2017). Ensuring that 90% of PLHIV are aware of their status will support enrolment in HIV care and achievement of these global treatment goals (UNAIDS, 2014a). Despite impressive efforts in scaling-up availability of HIV testing and treatment services in the region, including freely available HIV testing at most healthcare settings, testing uptake remains inadequate to reach the global goals (Church et al, 2017). Uptake of HIV testing remains low amongst poorer individuals and those
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