Article Text

Optimising the cost and delivery of HIV counselling and testing services in Kenya and Swaziland
  1. Carol Dayo Obure1,
  2. Anna Vassall1,
  3. Christine Michaels1,
  4. Fern Terris-Prestholt1,
  5. Susannah Mayhew1,
  6. Lucy Stackpool-Moore2,
  7. Charlotte Warren3,
  8. The Integra research team,,
  9. Charlotte Watts1
  1. 1Social and Mathematical Epidemiology Group (SAME), Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  2. 2International Planned Parenthood Federation (IPPF), London, UK
  3. 3Population Council, Nairobi, Kenya
  1. Correspondence to Anna Vassall, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK; anna.vassall{at}lshtm.ac.uk

Abstract

Background Approaches to HIV counselling and testing (HCT) within low-resource high HIV prevalence settings have shifted over the years from primarily client-initiated approaches to provider initiated. As part of an ongoing programme science research agenda, we examine the relative costs of provider-initiated testing and counselling (PITC) services compared with voluntary counselling and testing (VCT) services in the same health facilities in two low-resource settings: Kenya and Swaziland.

Methods Annual financial and economic costs and output measures were collected retrospectively from 28 health facilities. Total annual costs and average costs per client counselled and tested (C&T), and HIV-positive clients identified, were estimated.

Results VCT remains the predominant mode of HCT service delivery across both countries. However, unit cost per client C&T and per person testing HIV positive is lower for PITC than VCT across all facility types in Kenya, but the picture is mixed in Swaziland. Average cost per client C&T ranged from US$4.81 to US$6.11 in Kenya, US$6.92 to US$13.51 in Swaziland for PITC, and from US$5.05 to US$16.05 and US$8.68 to US$19.32 for VCT in Kenya and Swaziland, respectively.

Conclusions In the context of significant policy interest in optimising scarce HIV resources, this study demonstrates that there may be potential for substantial gains in efficiency in the provision of HCT services in both Kenya and Swaziland. However, considerations of how to deliver services efficiently need to be informed by local contextual factors, such as prevalence, service demand and availability of human resources.

  • Programme science
  • efficiency
  • health service integration
  • HTC
  • sub-Saharan Africa

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Footnotes

  • Funding This work was supported by the Bill and Melinda Gates Foundation, grant number 48733.

  • Correction notice This article has been corrected since it was published Online First. The sentence ‘In a twice-daily bid to encourage HCT uptake to population groups with limited access to existing services, the Ministries of Health of both Kenya and Swaziland mandated PITC throughout the health sector in 2008.’ has been updated to read ‘In a bid to encourage HCT uptake to population groups with limited access to existing services, the Ministries of Health of both Kenya and Swaziland mandated PITC throughout the health sector in 2008.’ Also, the repeat of the following sentence has been deleted “Financial costs represent actual expenditures on goods and services purchased, while economic costs include the estimated value of all resources, including donated or subsidised goods and services.”

  • Competing interests None.

  • Ethics approval Ethics approval was provided by London School of Hygiene and Tropical Medicine; Population Council Institutional Review Board; Kenya Medical Research Institute National Ethical Review Committee; Swaziland Scientific Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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