RT Journal Article
SR Electronic
T1 Optimising the cost and delivery of HIV counselling and testing services in Kenya and Swaziland
JF Sexually Transmitted Infections
JO Sex Transm Infect
FD BMJ Publishing Group Ltd
SP 498
OP 503
DO 10.1136/sextrans-2012-050544
VO 88
IS 7
A1 Obure, Carol Dayo
A1 Vassall, Anna
A1 Michaels, Christine
A1 Terris-Prestholt, Fern
A1 Mayhew, Susannah
A1 Stackpool-Moore, Lucy
A1 Warren, Charlotte
A1 ,
A1 Watts, Charlotte
YR 2012
UL http://sti.bmj.com/content/88/7/498.abstract
AB 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.