Establishing a Cost-Benefit Framework for Assessing Digitally Supported HIV Self-Testing

Summary

Aviro is looking for a Health Economist to perform an economic evaluation on Ithaka, a mhealth app for HIV self-testing.
This work is expected to take 20 days to complete and will include secondary research to validate assumptions, followed by a Cost-Benefit Analysis of Ithaka.

Applicant to please apply by 23 April 2021 – the selection is expected to be made by 30 April 30, with the work completed by 1 June 2021.

Ithaka Background

HIV Self-Testing (HIVST) has the potential to transform HIV prevention and management, but patient management and disease surveillance are very difficult when people test privately. High levels of digital penetration and literacy in middle-income countries open the opportunity to address these shortcomings using scalable digital interventions.

Developed by Aviro, Ithaka is a set of approved multi-language HIV counselling content and workflows, delivered through either offline app, data-free website, or WhatsApp chatbot, that walks users through awareness, pre-test counselling, testing, and linkage to services based on screening results. The tool helps users address common barriers to accessing testing and services, and gives providers critical data on usage and HIVST program outcomes.

Ithaka has so far been customised to 6 different user groups and intervention protocols, which have shown strong usability, willingness to use, and positive outcomes. Take-home testing supported by WhatsApp/web has yielded reporting rates up to 55% compared to less than 15% for other reporting mechanisms; positive yields aligned to expectations in given populations; and is now being tested to establish linkage to care rates. On-site self-testing in booths has very high reporting rates (95%+); strong positivity yield; and high linkage to care rates. In all cases, uptake has been strong with groups that are traditionally hard to test.
Future areas to improve impact include improving prevention by increasing support for regular testing, PReP, and VMMC; and using data to continuously improve operations and user experience to drive improvements in outcome.

Health Economics Need

Through pilot studies and a peer-reviewed journal article, Ithaka has shown strong health outcomes and usability, however, there is also a need to evaluate Ithaka’s economic impact. In order to effectively scale Ithaka and drive uptake through health providers (MoH, donors, NGOs), Aviro needs to better understand the economic value proposition of Ithaka, in order to:

  • Effectively communicate the potential health cost-benefit analysis of Ithaka, at various configurations, to potential payers.
  • Align internal product success metrics, costs, and funding to ensure the ongoing sustainability of the offering at a price point that is sufficiently attractive to drive uptake with providers.

Timelines and Deliverables

  • Scope (timeline)
  • Data collection (2 weeks)
  • Conduct secondary research to validate various assumptions about key inputs, in order to estimate the economic costs of HIV on a programme and national level
  • Conduct secondary research to validate various assumptions about key inputs,  in order to estimate the economic benefits of Ithaka, on a programme and national level
  • Meet with key stakeholders (internal and external) to validate various assumptions needed to estimate the costs of implementing Ithaka for providers, based on different types of implementations (on-site vs off-site, demand gen provided by Aviro or not, etc)
  • Economic evaluations (1 week). These evaluations should include Programme Cost Analysis of Ithaka, Cost of Illness Analysis of HIV, Cost-Effective analysis of Ithaka, and Cost-Benefit Analysis of Ithaka
  • Evaluate existing and previous Ithaka programmes, and use findings to create projected models for key potential buyers
  • These models should investigate various configurations of the price point/packages, public/private sector, and various health outcomes
  • Report findings (1 week)
  • The final report that includes a brief background of the assumptions, economic evaluations, and recommendations going forward

Aviro would like to engage a consultant who can, by June 1, 2021, complete the following deliverables:

  • Data collection
  • A framework that outlines the assumptions made for each of the economic evaluations needed, as well as their sources of validation
  • Google Drive folder with PDFs or links of all referenced materials used in the assumptions framework
  • Economic evaluations
  • An economic evaluation model, including sheets for each of the outlined analyses (for a variety of different configurations)
  • A cost-benefit analysis model, including sheets for each of Ithaka’s past and current programmes, as well as projected models for key potential buyers.
  • Report findings
  • Final health economics report, including a brief background of the assumptions, economic evaluations, and recommendations going forward
  • Slide deck summarizing the findings of the report (8-10 slides)

We feel that this work does not require primary research, but will require careful secondary research of health stats/economics in South Africa and Kenya, and significant engagement with key stakeholders in Aviro and with partner organisations (HST, NDOH, MSF, etc) to understand the solution and its various possible iterations, benefits, and costs, whether borne by Aviro or the provider.

What we are looking for

  • An enthusiastic, careful, and curious person with a strong background in Health Economics, Finance, Accounting, or similar
  • Experience constructing/visualizing/presenting health economics findings for lay stakeholders, that use assumptions to demonstrate cost-effectiveness.
  • A successful history of conducting economic evaluations (CE ratios, CUA or BCA) of assessing and recommending health interventions for public health systems to governments and/or international donors/funders
  • Proven stakeholder engagement skills and experience with coordinating across multiple specialisations to gather a full set of inputs needed to assess economic viability create recommendations
  • The ideal candidate will also have extensive experience in digital health and be located in South Africa or Kenya.

Aviro Health is an equal opportunity employer. We do not and will not discriminate on the basis of race, religion, gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, in any of our activities or operations.

If you are interested, please send your CV and a cover letter with the Subject: Health Economist (Please be REAL in your letter and tell us about you) to info@avirohealth.com