Cost outcomes and analysis
PRS
Total cost per individual with a reported positive test result and per individual linked to care were calculated using study data for both study arms. Costs were derived from a recent facility-based HIVST trial in which the cost of facility-based testing and HIVST were collected at neighboring sites in Malawi [In short, we applied a microcosting (bottom-up) approach from providers’ perspective, using the HIV Counselling and Testing costing tool developed by the Health Economics and Epidemiology Research Office in South Africa [For the PRS arm, the costs included: cost of counseling when given the PRS, cost of the partner testing at the clinic for those who returned, and the cost of confirmatory testing for those who tested positive. For the index HIVST arm, the costs included: cost of counseling when the HIVST kits were distributed, the cost of the distributed self-tests, and the cost of the clinic-based testing algorithm following a positive HIVST. For each cost component, the cost of human resources, training, equipment, consumables, and overhead were included. Costs are reported in 2018USD to reflect the time period of this trial. The costs of human resources, training, equipment, and overhead were inflated to 2018USD, while the cost of human resources, equipment, and overhead were adjusted from 2017USD to 2018USD to reflect the time period of this trial. Cost of HIV testing kits (both HIVST and provider testing kits) did not change between 2017 and 2018. The cost of an HIVST kit was assumed to be $2.Three types of cost outcomes were assessed: (1) Cost per test provided: calculated as the cost per person counseled and given PRS or HIVST; (2) cost per person aware of HIV status: calculated as the total cost of providing PRS or HIVST to all individuals in the trial divided by the number of people newly aware of their HIV–positive status (by arm); (3) cost per ART initiate: calculated as the total cost of providing PRS or HIVST to all individuals in the trial divided by the number of people newly initiating on ART (by arm).