rural communities in Malawi INDA 1 , , MANGENAH,COLLIN 2 , , - PowerPoint PPT Presentation

#IAS2017 | @IAS_conference Abstract no. TUPED1242 A user costs analysis for HIV testing among rural communities in Malawi INDA 1 , , MANGENAH,COLLIN 2 , , MWENGE,LAWRENCE 3 , EUMAN,MELISSA 4 , SANDE,LIN , NEU , PITCHAYA 1 , C, 4 JO CHERYL 5 , HATZOLD,KARIN 6 , INDRAVUNDH, IND , PIT , D’ELBÉE , , MARC, JOHNSON, CHE , HA , ELIZABETH 1,4 & FERN 4 CORBETT,L. . ELI & TERRIS-PRESTHOLT, , FER 1 ML ; 2 CESHHA ; 3 ZAMBART , ZAM AMBIA; 4 LONDON SC MLW, MALA MALAWI; HAR, ZIMBABWE; SCHO HOOL HY HYG TR TROP K; 5 WHO , ; 6 PSI, USA MED, UK; , SWITZ TZERLA LAND;

#IAS2017 | @IAS_conference Background • There are an estimated 24.7 million people living with HIV in sub-Saharan Africa which is approximately 71% of the global total Malawi: HIV prevalence (2015): • • 9.1% (980,000 individuals) Gap - UNAIDS 90 -90-90 : • • High rates of linkage to care and viral suppression • BUT only 73% of HIV+ know status (PEPFAR, 2016) Gender disparity: 67% men ; 76% women • Need to identify key barriers to uptake •

#IAS2017 | @IAS_conference Methods Baseline Household Survey - Adults aged ≥16 Years - Living in 22 Pre-Selected Enumeration Villages - N=5,559 -Random 25% sample asked to consent to: Extended Questionnaire - User Costs of HIV Testing - Discrete Choice Experiment - Included in current study if HIV tested in last 12 months - Completed costing questions & Recently tested (n=746;32% Men) - Tobit Regression Analysis for cost drivers

#IAS2017 | @IAS_conference Results 3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00 Transport Consultation Childcare Food Other Lost Income Men (US$) Women (US$)

#IAS2017 | @IAS_conference Results

#IAS2017 | @IAS_conference Conclusion • Despite HIV testing being provided free of charge and achieving reasonable uptake, observed user costs in rural Malawi were significant • Both user and service characteristics are drivers of user costs • These characteristics and financial burdens need to be considered in provision of HIV testing services

#IAS2017 | @IAS_conference Acknowledgements The study was undertaken in collaboration with UNITAID, PSI, WHO and the HIV Self- T esting Africa Research Consortium institutions