The costs and effectiveness of four HIV counseling and testing strategies in Uganda
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Date
2009
Journal Title
Journal ISSN
Volume Title
Publisher
Lippincott Williams & Wilkins.
Abstract
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.
Design: 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.
Methods: 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.
Results: 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.
Conclusion: 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 lowrates 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.
Description
Keywords
Africa, HIV, Uganda, voluntary counseling and testing
Citation
Menzies, N., Abang, B., Wanyenze, R., Nuwaha, F., Mugisha, B., Coutinho, A., ... & Blandford, J. M. (2009). The costs and effectiveness of four HIV counseling and testing strategies in Uganda. Aids, 23(3), 395-401.