The costs and effectiveness of four HIV counseling and testing strategies in Uganda

US Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, USA.
AIDS (London, England) (Impact Factor: 5.55). 01/2009; 23(3):395-401. DOI: 10.1097/QAD.0b013e328321e40b
Source: PubMed


HIV counseling and testing (HCT) is a key intervention for HIV/AIDS control, and new strategies have been developed for expanding coverage in developing countries. We compared costs and outcomes of four HCT strategies in Uganda.
A retrospective cohort of 84 323 individuals received HCT at one of four Ugandan HCT programs between June 2003 and September 2005. HCT strategies assessed were stand-alone HCT; hospital-based HCT; household-member HCT; and door-to-door HCT.
We collected data on client volume, demographics, prior testing and HIV diagnosis from project monitoring systems, and cost data from project accounts and personnel interviews. Strategies were compared in terms of costs and effectiveness at reaching key population groups.
Household-member and door-to-door HCT strategies reached the largest proportion of previously untested individuals (>90% of all clients). Hospital-based HCT diagnosed the greatest proportion of HIV-infected individuals (27% prevalence), followed by stand-alone HCT (19%). Household-member HCT identified the highest percentage of discordant couples; however, this was a small fraction of total clients (<4%). Costs per client (2007 USD) were $19.26 for stand-alone HCT, $11.68 for hospital-based HCT, $13.85 for household-member HCT, and $8.29 for door-to-door-HCT.
All testing strategies had relatively low per client costs. Hospital-based HCT most readily identified HIV-infected individuals eligible for treatment, whereas home-based strategies more efficiently reached populations with low rates of prior testing and HIV-infected people with higher CD4 cell counts. Multiple HCT strategies with different costs and efficiencies can be used to meet the UNAIDS/WHO call for universal HCT access by 2010.

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    • "The importance of HIV testing and counseling is not only to promptly identify HIV infected patients, but also provides the opportunity to talk about HIV prevention [24]. In the case of TB patients in Peru, because they are a generally young population and share similar demographic characteristics with vulnerable populations for HIV infection, HIV counseling and testing activities at the time of TB testing can provide the opportunity to address the potential lack of HIV knowledge among these vulnerable populations. "
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    • "The interaction and information giving within PITC is shorter to enable integration within busy health facilities and it seems to work well for the majority of the patients [6,9,16,17]. There were a few individuals in both PITC and VCT who did not find the information adequate. "
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    • "In general, however, the evidence about how socio-economic factors influence testing comes from disparate studies using different measures and does not distinguish among different components of socio-economic status, which may operate in different ways: although education and wealth are associated with higher infection in some settings, educational attainment may increase uptake of testing through increased recognition of the importance of knowing one's HIV status and greater control over the decision to test (Jukes et al. 2008), whereas wealth may be associated with greater awareness of risks and with reduced financial barriers to testing (Mishra et al. 2007; Parkhurst 2010). Moreover, most studies simply measure whether individuals have been tested or not, and only a few studies have examined the impact of particular ways of providing testing (Helleringer et al. 2009; Menzies et al. 2009). To generalise about the extent to which different modes of testing increase uptake among those with different socio-economic characteristics , it is necessary to go beyond studies conducted in individual sites and to undertake systematic comparisons of testing in settings that vary by mode of testing and among groups that vary by socio-economic characteristics. "
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