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Cost of Using Multipoint Video-Technology for National Guidelines
Dissemination in Kenya
1B. Mambo, 1M. Kimani, 2L. Misiko, 3K.Owour, 1A. Wachira, 1I. Mukui, 1 B. Kigen
1National AIDS and STI Control Programme, Ministry of Health, Directorate of Preventive and
Promotive Health Services, Nairobi, Kenya. 2University of Maryland, Baltimore.
BACKGROUND:
HIV infection continues to be a public health threat in Kenya with 1.5 million Kenyans estimated
to be living with HIV of whom approximately 1,000,000 are on antiretroviral therapy. Every 2
years, the MOH through its unit the National AIDS and STI Control Program, NASCOP, releases
updated National ART guidelines and provides overall leadership and training to collaborators at
the national, regional, and site levels.
Traditionally, Master TOTs from a pool of national mentors with similar competencies are selected
to attend a didactic classroom training based on revised Orientation Packages. Two different
training methods were employed for the 2016 and 2018 guideline for the national mentors: A
didactic teaching class that the mentors have to travel to and take approximately 96 hours to
complete, and a multipoint video conferencing technology that the mentors logged on remotely
from their work stations and lasted approximately 10 hours respectively.
The objective of this analysis is to demonstrate the cost and efficiency of leveraging on
teleconference model for dissemination of guidelines.
METHODS:
We assessed performed the analysis US$, and looked at cost (cost per training via didactic method
versus cost per training using multi point video technology), efficiency (monetary cost and cost of
time saved), and output of the training (pre and post test scores of participants in both modalities).
The Cost Efficiency Ratio (CER) was defined as {Total Cost (Didactic) - Total Cost (Multipoint
Video)} divided by {Number Trained or hours (Didactic) - Number Trained or hours (Multipoint
Video)}.
Analysis was done using Stata software version 15.1.
RESULTS
Using didactic approach for training was associated with an average marginal cost of $49,210.00
for a class of 60 participants, and $820.17 per training a participant. In comparison, the average
marginal cost of training using multi point video technology was $1550.00 for a class of 74
participants, and a total cost of $20.96 per participant trained. The Cost Efficiency Ratio (C.E.R)
of using multipoint video technology was $3404.29
On average time spent for the multipoint video technology was 10 hours, compared to 96 hours
spent using the didactic method, giving us a CER of $554.19.
Overall and marginal costs of training were associated with per diem costs [initial ($13,400.00 vs.
$0.00) transport costs (fuel/reimbursements) ($1,900.00 vs. $0.00), with administrative costs
(printing, stationary, hotel packages, airtime, bundles) ($33,910.00 vs. $1550.00).
Comparison of the pre and post test of the two methods used was similar, with both giving an
average pre-test score of 74% and a post test score of 74% and 75% respectively (p value 0.937)
CONCLUSIONS
Guidelines dissemination using multipoint video technology for training lead mentors is
inexpensive, feasible and has reduced cost. Also the output of the post test demonstrated no
reduction in knowledge gained as the results were similar.