Evaluating effectiveness and comparative costs of hepatitis C virus self-testing service delivery models in Vietnam: A cross-sectional study

TL;DR

This study compares the effectiveness and costs of different hepatitis C self-testing models in Vietnam, finding that self-testing reaches more first-time testers but is currently more expensive than standard testing.

Contribution

The study evaluates HCV self-testing models in real-world settings and quantifies their cost-effectiveness in key populations in Vietnam.

Findings

HCV self-testing reached more first-time testers compared to standard testing, especially through community and secondary distribution models.

HCV self-testing at community organizations was more costly than standard testing, but costs could become comparable with reduced test kit prices.

HCV positivity rates were lower with self-testing at community organizations but similar at clinics compared to standard testing.

Abstract

Hepatitis C virus self-testing (HCVST) has been shown to reach people who may not otherwise test. We conducted a cross-sectional survey to assess the effectiveness and costs of different HCVST distribution models among key populations (KPs) and people living with HIV (PLHIV) in Hanoi and Ho Chi Minh City, Vietnam, between September 2023 and April 2024. We engaged eight community-based organizations (CBOs) and 10 public and private clinics in offering HCVST using oral fluid-based HCV rapid antibody tests along with standard or provider-led HCV testing (HCVT). HCVST effectiveness was assessed by the proportion of first-time testers, HCV positivity yield, and linkage to care. Outcomes were stratified by distribution model (community, facility, online, secondary distribution) and compared to standard HCVT. Cost per HCV diagnosis was calculated in US dollars. Among 2,882 participants tested for HCV, 1,834 used HCVST and 1,048 used standard HCVT. HCVST users were more likely to be first-time testers compared to those opting for standard testing (67.6% vs. 59,1%; p < 0.001). The highest proportion of first-time testers was reached through secondary distribution (91.4%) and community distribution (83.8%). HCV positivity through HCVST was significantly lower at CBOs but similar at clinics compared to standard testing (11% vs. 16%; p < 0.01; 16.8% vs. 20.8%; p = 0.094). HCVST at CBOs and clinics was more costly than standard testing ($636 vs. $408 and $605 vs. $218). HCVST was still costlier at CBOs but cheaper at clinics compared to standard testing when kit costs decreased to $2 ($417 vs. $218 and $357 vs. $408). HCVST effectively reached people with HCV and more first-time testers, compared to standard testing among KPs and PLHIV. While current HCVST distribution approaches are costlier than standard testing, modest reductions in commodity costs could make services comparable to help achieve Vietnam’s HCV elimination goals and reach underserved populations.

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