Using HIV infrastructure to test for other diseases can reach many people at a low cost

Cost and efficiency of a hybrid mobile multi-disease testing approach with high HIV testing coverage in East Africa.

Chang W, Chamie G, Mwai D, Clark TD, Thirumurthy H, Charlebois ED, Petersen M, Kabami J, Ssemmondo E, Kadede K, Kwarisiima D, Sang N, Bukusi EA, Cohen CR, Kamya M, Havlir DV, Kahn JG. J Acquir Immune Defic Syndr. 2016 Jul 29. [Epub ahead of print]

Background: In 2013-14, 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, multi-disease services, and community mobilization.

Methods: We applied micro-costing methods to estimate costs of population-wide HIV testing in 12 SEARCH Trial communities. Main intervention components of the hybrid approach are census, multi-disease community health campaigns (CHC), and home-based testing (HBT) for CHC non-attendees. 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 via HBT. The cost per HIV+ adult identified was $231 ($87 - $1245), with variability due mainly to HIV prevalence among persons tested (i.e., HIV positivity rate). The marginal costs of multi-disease 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, multi-disease services were offered at low marginal costs.

Abstract access  [1]

Editor’s notes: Ensuring high rates of HIV testing is critical to managing the HIV epidemic in many countries. With a positive diagnosis, recent WHO recommendations suggest that people living with HIV can immediately be put onto treatment which improves their own health, alongside reducing the chance that they will pass on infection to others. There are many different ways to carry out HIV testing, and this study looks at the differences in costs between community health campaigns (which also test for other diseases including hypertension and diabetes), and home-based testing. This paper estimates that it was less costly to carry out a HIV test through a multi-disease community programme than home-based testing. The authors suggest that because of the robust infrastructure that has been developed for HIV testing in Uganda and Kenya, the additional cost for testing for other diseases is very low. There has been some criticism that the response to the HIV epidemic has been at the expense of reducing ill-health from other conditions. Using HIV infrastructure to support testing for diseases like hypertension and diabetes is a good way to counter these criticisms, and improve the overall health of the population. 

Africa [5]
Kenya [6], Uganda [7]
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