Cost effectiveness of facility and home based HIV voluntary counseling and testing strategies in rural Uganda

Abstract

Background: In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) has been at health facilities. Home based VCT on the other hand, was initiated in the country to improve service coverage. Objective: To evaluate the cost effectiveness of facility-and home-based HIV VCT strategies in rural southwestern Uganda. Methods: Data on costs and effectiveness of facility-and home-based HIV VCT intervention strategies was collected in two sub-Counties in rural southwestern Uganda. Costing was performed using the ingredients approach. Effectiveness was measured as the number of HIV sero-positive clients identified. Incremental Cost-Effectiveness Ratios (ICERs) were calculated from the provider perspective. Results: The cost per client tested were US$6.4 for facility based VCT and US$5.0 for home based VCT. The corresponding costs per positive case identified were US$86.5 and US$54.7 respectively. The incremental cost to providers per additional positive case identified by facility based VCT was US$3.5. Conclusion: Home based VCT was the least costly strategy per client tested and was also cost effective in identifying HIV sero-positive clients in rural areas. This strategy should therefore be promoted to improve service coverage and thereby facilitate early and extensive detection of clients eligible for treatment.

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

“…The cost per person tested was highest for stand-alone VCT ($36.78) 88,93,142 whereas hospital and clinic HTC had similar costs ($12.56 and $12.32, respectively) 81,88,93,140,142–147 (Supplementary Table S3 and Figure S62). Costs were dependent on the country where the study was conducted, which costs were included (start-up or ongoing only) and the intervention scale.…”

Barriers to Linkage to HIV Care in Ugandan Fisherfolk Communities: A Qualitative Analysis

“…Further, other types of testing models may be more conducive to testing larger numbers of fisherfolk and increasing serostatus awareness in fisherfolk communities, a first step to increasing the number of fisherfolk on ART. For example, home-based HIV counseling and testing, as well as home-based ART provision, have been shown to be cost-effective and acceptable to clients in rural Ugandan communities [32, 42-46], as well as in other sub-Saharan countries [47-49], and thus may be worthy of further exploration for fisherfolk.…”

Mobilization for HIV Voluntary Counseling and Testing Services in Vietnam: Clients’ Risk Behaviors, Attitudes and Willingness to Pay

“…VCT has been recognized as a cost-effective part of the overall control strategy of the HIV/AIDS epidemic [8][9][10]. VCT supports an individual to make an informed choice about being tested for HIV through counseling [11].…”