Costs of integrating HIV self-testing in public health facilities in Malawi, South Africa, Zambia and Zimbabwe.

INTRODUCTION: As countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner's use) distribution alone or primary (own use) and secondary distribution approaches. METHODS: We evaluated the costs of adding HIVST to existing HIV testing from the providers' perspective in the 31 public health facilities across the four countries between 2018 and 2019. We combined expenditure analysis and bottom-up costing approaches. We also carried out time-and-motion studies on the counsellors to estimate the human resource costs of introducing and demonstrating how to use HIVST for primary and secondary use. RESULTS: A total of 41 720 kits were distributed during the analysis period, ranging from 1254 in Zimbabwe to 27 678 in Zambia. The cost per kit distributed through the primary distribution approach was $4.27 in Zambia and$9.24 in Zimbabwe. The cost per kit distributed through the secondary distribution approach ranged from $6.46 in Zambia to$13.42 in South Africa, with a wider variation in the average cost at facility-level. From the time-and-motion observations, the counsellors spent between 20% and 44% of the observed workday on HIVST. Overall, personnel and test kit costs were the main cost drivers. CONCLUSION: The average costs of distributing HIVST kits were comparable across the four countries in our analysis despite wide cost variability within countries. We recommend context-specific exploration of potential efficiency gains from these facility-level cost variations and demand creation activities to ensure continued affordability at scale

Tribal-Run Health Systems

Jessica Bylander (Apr 2017) reported on the desire of the Rosebud Sioux Tribe in South Dakota to run their health system independently from the Indian Health Service. Bylander mentioned as an example of an “impressive success story” and an inspiration to the Rosebud Sioux the health systems of Alaska Native tribes—which adopted tribal governance in 1998.1However, data from the Alaska Department of Health and Social Services show poor health outcomes for Alaska Native people despite the tribal takeover. For example, during the period 2000–15, infant mortality worsened by 80 percent,2 while alcohol-induced mortalities increased by 22 percent.3 During the same period there was a 22 percent increase in adults claiming that cost was a barrier to health care.4 In light of these unsatisfactory health outcomes, it appears that the Alaska Native tribes’ health systems cannot be considered impressive success stories of tribal-run health systems

The Impact and Spillover Effects of HIV Self-Test Technology on HIV Outcomes of the South African Working Class

Background: South Africa recently adopted HIV self-test technology (HIVST) to improve HIV testing and encourage earlier treatment initiation in working populations with a low uptake of conventional testing approaches. This study investigates the impact of HIVST on testing outcomes, focusing on both frequent and infrequent working-class testers. The paper also examines the spillover effect of HIVST on antiretroviral (ART) treatment initiation. To identify these effects, the author focused on South Africa and exploited the HIVST distribution data of 6259 beneficiaries of HIVST. Methods: The author used a two-stage least-squared model to quantify the impact of the HIVST on these vulnerable working populations. Results: The results show that HIVST fosters a 27.6% higher testing uptake in infrequently testing workers compared to frequently testing workers, and that the uptake of HIVST is 11.5% higher in rural regions than in urban settings, as well as 14.5% more prominent in infrequent male testers than infrequent female testers. Notably, the positive effects of HIVST are also confirmed by the presence of positive spillover effects in workers screening positive for HIV. The paper documents a 7.6% increase in ART initiation in infrequent testers. Conclusions: There is a case for adopting this technology to improve the uptake of HIV testing and ART initiation as the country seeks to attain the UNAIDS 95–95–95 targets by 2030

Sugar-Sweetened Beverage Tax In Mexico

Arantxa Colchero and coauthors (Mar 2017) used household data and reported that a tax on sugar-sweetened beverages in Mexico—implemented on January 1, 2014—had yielded an average annual reduction of 7.6 percent in the purchase of the taxed beverages during the period 2014–15. However, the 2015 annual report of a leading beverage company in Mexico showed a 2.6 percent growth in the sale volume of Coca-Cola. 1 This figure reflects a recovery from the 2014 decline in volume that was associated with bad weather conditions. Given that the study by Colchero and coauthors covered only 6,645 households and did not consider the national perspective or the impact of weather in 2014, it appears that the tax on sugar-sweetened beverages has not curbed the overall consumption of these beverages nationally in Mexico. Furthermore, the alleged reduction in the consumption of sugar-sweetened beverages cannot be linked to a reduction in obesity levels, 2,3 which is the goal of the tax. 4 In light of this observation, other countries considering the implementation of a tax on sugar-sweetened beverages may need to be cautious. The tax in Mexico has not yet produced the intended outcome

Macroeconomics and health: Understanding the impact of a declining economy on health outcomes of children and young adults in South Africa

Background: The current covid-19 economic crisis continues to weaken economic growth in South Africa. This study was designed to show how a declining economic state affects the mental health conditions, metabolic risk factors, communicable conditions, and non-communicable conditions of adolescent (18-year cohorts) and adult (25-year cohorts) population groups comparatively. Study design: This was a panel analysis using secondary data issued by Statistic South Africa. Methods: The author used a Two-stage Least Squared Model (2SLS) to quantify the impact of the declining economy on mental health conditions (depression and traumatic stress), non-communicable conditions (cancer and diabetes), metabolic risk factors (alcohol abuse and hypertension), and communicable conditions (influenza, diarrhea, dry cough) of both adolescent and young adult population groups. Each group comprised a treatment and a control group. Results: The declining economic state of 2008–2014 worsens the mental health conditions, metabolic risk factors, and non-communicable conditions of adolescent and young adult populations. However, the declining economy reduced cases of communicable conditions. The impact of the declining economy worsens mental health conditions, metabolic risk factors, and non-communicable conditions more in urban settings than in rural regions. Men abuse alcohol more than women during economic decline, triggering worsening mental health conditions, hypertension, and non-communicable conditions, especially in the adult population residing in urban settings. Conclusions: Economic decline worsen mental health conditions, metabolic risk factors, and non-communicable conditions. The South African government may want to prioritize these conditions as covid-19 economic shocks continue to backslide economic growth

Sugar-sweetened beverage tax in Mexico

Arantxa Colchero and coauthors (Mar 2017) used household data and reported that a tax on sugar-sweetened beverages in Mexico—implemented on January 1, 2014—had yielded an average annual reduction of 7.6 percent in the purchase of the taxed beverages during the period 2014–15. However, the 2015 annual report of a leading beverage company in Mexico showed a 2.6 percent growth in the sale volume of Coca-Cola. 1 This figure reflects a recovery from the 2014 decline in volume that was associated with bad weather conditions. Given that the study by Colchero and coauthors covered only 6,645 households and did not consider the national perspective or the impact of weather in 2014, it appears that the tax on sugar-sweetened beverages has not curbed the overall consumption of these beverages nationally in Mexico. Furthermore, the alleged reduction in the consumption of sugar-sweetened beverages cannot be linked to a reduction in obesity levels, 2,3 which is the goal of the tax. 4 In light of this observation, other countries considering the implementation of a tax on sugar-sweetened beverages may need to be cautious. The tax in Mexico has not yet produced the intended outcome