OBJECTIVES

: Stigmas associated with HIV in the Kingdom of Saudi Arabia (KSA) have resulted in decreased testing in those at high risk of acquiring HIV infection; ultimately, this increases the clinical, humanistic, and economic burden on KSA. To assess the cost incurred due to the impact of these stigmas, we hypothesized that addressing the consequences of these stigmas on diagnosis rates, through testing of pregnant women to prevent mother-to-child transmission (PMTCT) and HIV self-testing (HIVST), will lead to an increase in the number of diagnosed and linked-to-care patients. The resulting cost savings would be indicative of the cost associated with stigma. Hence, a health-economic model was developed to estimate the cost-effectiveness of these interventions in KSA.

METHODS

: A Markov model was built to estimate the costs associated with people living with HIV (PLHIV) subject to prevention of mother-to-child transmission (PMTCT) and HIVST, over 20-years (control). Data sources included the KSA National AIDS Programme, Demographic Survey 2016 (KSA General Authority for Statistics) and UNAIDS. The model included seven health states: general population, undiagnosed, diagnosed, treated, and symptomatic HIV patients, deaths due to HIV, and background mortality. Stigmas related to having unprotected sex, testing for HIV infection as a member of a risk group, and seeking treatment if infected, were included. Base-case scenario was maintaining status quo and not implementing either interventions.

RESULTS

: Over the 20-year horizon, implementing PMTCT and HIVST prevented 12,800 and 15,600 new infections respectively vs. the base-case. Additionally, Implementing PMTCT and HIVST are projected to have a net cost saving of 151.4 and 336.9 million SAR respectively from the country’s estimated expenditures on HIV management over 20 years.

CONCLUSIONS

: PMTCT and HIVST are cost-saving stigma-addressing interventions for PLHIV in KSA. Not addressing stigma in high-risk groups and general population could result in incurring a sizable “cost of stigma”.