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Implementation and Operational Research: Cost and Efficiency of a Hybrid Mobile Multidisease Testing Approach with High HIV Testing Coverage in East Africa

Citation

Chang, Wei; Chamie, Gabriel; Mwai, Daniel N.; Clark, Tamara D.; Thirumurthy, Harsha; Charlebois, Edwin D.; Petersen, Maya L.; Kabami, Jane; Ssemmondo, Emmanuel; & Kadede, Kevin, et al. (2016). Implementation and Operational Research: Cost and Efficiency of a Hybrid Mobile Multidisease Testing Approach with High HIV Testing Coverage in East Africa. Journal of Acquired Immune Deficiency Syndromes, 73(3), e39-45. PMCID: PMC5089839

Abstract

BACKGROUND: In 2013-2014, we achieved 89% adult HIV testing coverage using a hybrid testing approach in 32 communities in Uganda and Kenya (SEARCH: NCT01864603). To inform scalability, we sought to determine: (1) overall cost and efficiency of this approach; and (2) costs associated with point-of-care (POC) CD4 testing, multidisease services, and community mobilization.
METHODS: We applied microcosting methods to estimate costs of population-wide HIV testing in 12 SEARCH trial communities. Main intervention components of the hybrid approach are census, multidisease community health campaigns (CHC), and home-based testing for CHC nonattendees. POC CD4 tests were provided for all HIV-infected participants. Data were extracted from expenditure records, activity registers, staff interviews, and time and motion logs.
RESULTS: The mean cost per adult tested for HIV was $20.5 (range: $17.1-$32.1) (2014 US$), including a POC CD4 test at $16 per HIV+ person identified. Cost per adult tested for HIV was $13.8 at CHC vs. $31.7 by home-based testing. The cost per HIV+ adult identified was $231 ($87-$1245), with variability due mainly to HIV prevalence among persons tested (ie, HIV positivity rate). The marginal costs of multidisease testing at CHCs were $1.16/person for hypertension and diabetes, and $0.90 for malaria. Community mobilization constituted 15.3% of total costs.
CONCLUSIONS: The hybrid testing approach achieved very high HIV testing coverage, with POC CD4, at costs similar to previously reported mobile, home-based, or venue-based HIV testing approaches in sub-Saharan Africa. By leveraging HIV infrastructure, multidisease services were offered at low marginal costs.

URL

http://dx.doi.org/10.1097/qai.0000000000001141

Reference Type

Journal Article

Year Published

2016

Journal Title

Journal of Acquired Immune Deficiency Syndromes

Author(s)

Chang, Wei
Chamie, Gabriel
Mwai, Daniel N.
Clark, Tamara D.
Thirumurthy, Harsha
Charlebois, Edwin D.
Petersen, Maya L.
Kabami, Jane
Ssemmondo, Emmanuel
Kadede, Kevin
Kwarisiima, Dalsone
Sang, Norton Mutai
Bukusi, Elizabeth A.
Cohen, Craig R.
Kamya, Moses R.
Havlir, Diane V.
Kahn, James G.

PMCID

PMC5089839