Wei Chang1, Gabriel Chamie, Daniel Mwai, Tamara D Clark, Harsha Thirumurthy, Edwin D Charlebois, Maya Petersen, Jane Kabami, Emmanuel Ssemmondo, Kevin Kadede, Dalsone Kwarisiima, Norton Sang, Elizabeth A Bukusi, Craig R Cohen, Moses Kamya, Diane V Havlir, James G Kahn. 1. *Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA; †Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA; ‡School of Economics, University of Nairobi, Nairobi, Kenya; §Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC; ‖Center for AIDS Prevention Studies, University of California, San Francisco, CA; ¶Department of Biostatistics, University of California, Berkeley, CA; #Infectious Disease Research Collaboration, Kampala, Uganda; **Kenya Medical Research Institute, Nairobi, Kenya; ††Division of HIV Prevention, Makerere University Joint AIDS Program, Kampala, Uganda; ‡‡Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA; and §§Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Abstract
BACKGROUND: In 2013-2014, we achieved 89% adult HIV testing coverage using a hybrid testing approach in 32 communities in Uganda and Kenya (SEARCH: NCT01864603). To inform scalability, we sought to determine: (1) overall cost and efficiency of this approach; and (2) costs associated with point-of-care (POC) CD4 testing, multidisease services, and community mobilization. METHODS: We applied microcosting methods to estimate costs of population-wide HIV testing in 12 SEARCH trial communities. Main intervention components of the hybrid approach are census, multidisease community health campaigns (CHC), and home-based testing for CHC nonattendees. POC CD4 tests were provided for all HIV-infected participants. Data were extracted from expenditure records, activity registers, staff interviews, and time and motion logs. RESULTS: The mean cost per adult tested for HIV was $20.5 (range: $17.1-$32.1) (2014 US$), including a POC CD4 test at $16 per HIV+ person identified. Cost per adult tested for HIV was $13.8 at CHC vs. $31.7 by home-based testing. The cost per HIV+ adult identified was $231 ($87-$1245), with variability due mainly to HIV prevalence among persons tested (ie, HIV positivity rate). The marginal costs of multidisease testing at CHCs were $1.16/person for hypertension and diabetes, and $0.90 for malaria. Community mobilization constituted 15.3% of total costs. CONCLUSIONS: The hybrid testing approach achieved very high HIV testing coverage, with POC CD4, at costs similar to previously reported mobile, home-based, or venue-based HIV testing approaches in sub-Saharan Africa. By leveraging HIV infrastructure, multidisease services were offered at low marginal costs.
BACKGROUND: In 2013-2014, we achieved 89% adult HIV testing coverage using a hybrid testing approach in 32 communities in Uganda and Kenya (SEARCH: NCT01864603). To inform scalability, we sought to determine: (1) overall cost and efficiency of this approach; and (2) costs associated with point-of-care (POC) CD4 testing, multidisease services, and community mobilization. METHODS: We applied microcosting methods to estimate costs of population-wide HIV testing in 12 SEARCH trial communities. Main intervention components of the hybrid approach are census, multidisease community health campaigns (CHC), and home-based testing for CHC nonattendees. POC CD4 tests were provided for all HIV-infectedparticipants. Data were extracted from expenditure records, activity registers, staff interviews, and time and motion logs. RESULTS: The mean cost per adult tested for HIV was $20.5 (range: $17.1-$32.1) (2014 US$), including a POC CD4 test at $16 per HIV+ person identified. Cost per adult tested for HIV was $13.8 at CHC vs. $31.7 by home-based testing. The cost per HIV+ adult identified was $231 ($87-$1245), with variability due mainly to HIV prevalence among persons tested (ie, HIV positivity rate). The marginal costs of multidisease testing at CHCs were $1.16/person for hypertension and diabetes, and $0.90 for malaria. Community mobilization constituted 15.3% of total costs. CONCLUSIONS: The hybrid testing approach achieved very high HIV testing coverage, with POC CD4, at costs similar to previously reported mobile, home-based, or venue-based HIV testing approaches in sub-Saharan Africa. By leveraging HIV infrastructure, multidisease services were offered at low marginal costs.
Authors: M Sweat; S Gregorich; G Sangiwa; C Furlonge; D Balmer; C Kamenga; O Grinstead; T Coates Journal: Lancet Date: 2000-07-08 Impact factor: 79.321
Authors: Bruce A Larson; Kathryn Schnippel; Buyiswa Ndibongo; Thembisile Xulu; Alana Brennan; Lawrence Long; Matthew P Fox; Sydney Rosen Journal: J Acquir Immune Defic Syndr Date: 2012-10-01 Impact factor: 3.731
Authors: Jennifer A Smith; Monisha Sharma; Carol Levin; Jared M Baeten; Heidi van Rooyen; Connie Celum; Timothy B Hallett; Ruanne V Barnabas Journal: Lancet HIV Date: 2015-04 Impact factor: 12.767
Authors: Niklaus Daniel Labhardt; Masetsibi Motlomelo; Bernard Cerutti; Karolin Pfeiffer; Mashaete Kamele; Michael A Hobbins; Jochen Ehmer Journal: PLoS Med Date: 2014-12-16 Impact factor: 11.069
Authors: Lucy Anne Parker; Kiran Jobanputra; Lorraine Rusike; Sikhathele Mazibuko; Velephi Okello; Bernhard Kerschberger; Guillaume Jouquet; Joanne Cyr; Roger Teck Journal: Trop Med Int Health Date: 2015-04-02 Impact factor: 2.622
Authors: Gabriel Chamie; Tamara D Clark; Jane Kabami; Kevin Kadede; Emmanuel Ssemmondo; Rachel Steinfeld; Geoff Lavoy; Dalsone Kwarisiima; Norton Sang; Vivek Jain; Harsha Thirumurthy; Teri Liegler; Laura B Balzer; Maya L Petersen; Craig R Cohen; Elizabeth A Bukusi; Moses R Kamya; Diane V Havlir; Edwin D Charlebois Journal: Lancet HIV Date: 2016-01-26 Impact factor: 12.767
Authors: Gabriel Chamie; Matthew D Hickey; Dalsone Kwarisiima; James Ayieko; Moses R Kamya; Diane V Havlir Journal: Curr HIV/AIDS Rep Date: 2020-08 Impact factor: 5.071
Authors: Diane V Havlir; Laura B Balzer; Edwin D Charlebois; Tamara D Clark; Dalsone Kwarisiima; James Ayieko; Jane Kabami; Norton Sang; Teri Liegler; Gabriel Chamie; Carol S Camlin; Vivek Jain; Kevin Kadede; Mucunguzi Atukunda; Theodore Ruel; Starley B Shade; Emmanuel Ssemmondo; Dathan M Byonanebye; Florence Mwangwa; Asiphas Owaraganise; Winter Olilo; Douglas Black; Katherine Snyman; Rachel Burger; Monica Getahun; Jackson Achando; Benard Awuonda; Hellen Nakato; Joel Kironde; Samuel Okiror; Harsha Thirumurthy; Catherine Koss; Lillian Brown; Carina Marquez; Joshua Schwab; Geoff Lavoy; Albert Plenty; Erick Mugoma Wafula; Patrick Omanya; Yea-Hung Chen; James F Rooney; Melanie Bacon; Mark van der Laan; Craig R Cohen; Elizabeth Bukusi; Moses R Kamya; Maya Petersen Journal: N Engl J Med Date: 2019-07-18 Impact factor: 91.245
Authors: Linda-Gail Bekker; George Alleyne; Stefan Baral; Javier Cepeda; Demetre Daskalakis; David Dowdy; Mark Dybul; Serge Eholie; Kene Esom; Geoff Garnett; Anna Grimsrud; James Hakim; Diane Havlir; Michael T Isbell; Leigh Johnson; Adeeba Kamarulzaman; Parastu Kasaie; Michel Kazatchkine; Nduku Kilonzo; Michael Klag; Marina Klein; Sharon R Lewin; Chewe Luo; Keletso Makofane; Natasha K Martin; Kenneth Mayer; Gregorio Millett; Ntobeko Ntusi; Loyce Pace; Carey Pike; Peter Piot; Anton Pozniak; Thomas C Quinn; Jurgen Rockstroh; Jirair Ratevosian; Owen Ryan; Serra Sippel; Bruno Spire; Agnes Soucat; Ann Starrs; Steffanie A Strathdee; Nicholas Thomson; Stefano Vella; Mauro Schechter; Peter Vickerman; Brian Weir; Chris Beyrer Journal: Lancet Date: 2018-07-20 Impact factor: 79.321
Authors: Starley B Shade; Thomas Osmand; Dalsone Kwarisiima; Lillian B Brown; Alex Luo; Betty Mwebaza; Aine Ronald Mwesigye; Enos Kwizera; Haawa Imukeka; Florence Mwanga; James Ayieko; Asiphas Owaraganise; Elizabeth A Bukusi; Craig R Cohen; Edwin D Charlebois; Douglas Black; Tamara D Clark; Maya L Petersen; Moses R Kamya; Diane V Havlir; Vivek Jain Journal: AIDS Date: 2021-05-01 Impact factor: 4.632