Cost-effectiveness of facility-based, stand-alone and mobile-based voluntary counseling and testing for HIV in Addis Ababa, Ethiopia

Abstract

Background Globally, there is a consensus to end the HIV/AIDS epidemic by 2030, and one of the strategies to achieve this target is that 90% of people living with HIV should know their HIV status. Even if there is strong evidence of clients’ preference for testing in the community, HIV voluntary counseling and testing (VCT) continue to be undertaken predominantly in health facilities. Hence, empirical cost-effectiveness evidence about different HIV counseling and testing models is essential to inform whether such community-based testing are justifiable compared with additional resources required. Therefore, the purpose of this study was to compare the cost-effectiveness of facility-based, stand-alone and mobile-based HIV voluntary counseling and testing methods in Addis Ababa, Ethiopia. Methods Annual economic costs of counseling and testing methods were collected from the providers’ perspective from July 2016 to June 2017. Ingredients based bottom-up costing approach was applied. The effectiveness of the interventions was measured in terms of the number of HIV seropositive clients identified. Decision tree modeling was built using TreeAge Pro 2018 software, and one-way and probabilistic sensitivity analyses were conducted by varying HIV positivity rate, costs, and probabilities. Results The cost of test per client for facility-based, stand-alone and mobile-based VCT was $5.06, $6.55 and $3.35, respectively. The unit costs of test per HIV seropositive client for the corresponding models were $158.82, $150.97 and $135.82, respectively. Of the three models, stand-alone-based VCT was extendedly dominated. Mobile-based VCT costs, an additional cost of USD 239 for every HIV positive client identified when compared to facility-based VCT. Conclusion Using a mobile-based VCT approach costs less than both the facility-based and stand-alone approaches, in terms of both unit cost per tested individual and unit cost per HIV seropositive cases identified. The stand-alone VCT approach was not cost-effective compared to facility-based and mobile-based VCT. The incremental cost-effectiveness ratio for mobile-based VCT compared with facility-based VCT was USD 239 per HIV positive case.

The potential use of digital health technologies in the African context: a systematic review of evidence from Ethiopia

“…There were 29 publications identified in the mHealth field 48 – 76 , involving a total of 574,649 study participants: 402,542 patients, 171,295 healthy individuals, and 812 healthcare professionals. The most common citations were on the potential use of mHealth for maternal, child, and reproductive health, covering 52% (15/29) of the citations, followed by infectious diseases, 48% (14/29).…”

“…The studies had emerging insights into the potential use of mHealth to transform healthcare and improve access to services by addressing financial, social, or geographic factors, though the findings were not consistent. In a study that compared the cost-effectiveness of facility-based, stand-alone, and mobile-based HIV voluntary counseling and testing, the results revealed a cost-effective and improved VCT service with the use of mobile phones when compared with the two arms 48 . A study that assessed the potential of telephone calls to identify and follow-up post-surgery infections and total complications reported the telephone calls were feasible and valuable 50 .…”

Contextualization of cost-effectiveness evidence from literature for 382 health interventions for the Ethiopian essential health services package revision

“…The detailed steps used to select the interventions are presented elsewhere [ 6 , 22 ]. From the total of 1018 unique interventions that were considered in the Ethiopian EHSP, the cost-effectiveness ratio was calculated using primarily the WHO-CHOICE GCEA approach for 144 interventions [ 23 ]. Additionally, we collected cost-effectiveness evidence for 771 interventions from the literature, excluding 64 multisector nutrition interventions and 39 emergency and critical care interventions [ 22 ].…”

The potential of digital health technologies in African context, Ethiopia

“…There were 25 publications identified in the mHealth field, 46–70 involving a total of 573,623 study participants: 401,563 patients, 171,295 healthy individuals, and 765 healthcare professionals. The most common citations were on the potential use of mHealth for maternal, child, and reproductive health, covering 60% (15/25) of the citations, followed by infectious diseases, 44% (11/25).…”

“…In a study that compared the cost-effectiveness of facility-based, stand-alone, and mobile-based HIV voluntary counseling and testing, the results revealed a cost-effective and improved VCT service with the use of mobile phones when compared with the two arms. 46 A study that assessed the potential of telephone calls to identify and follow-up post-surgery infections and total complications reported the telephone calls were feasible and valuable. 48 A similar study that assessed the potential of cell phones to follow-up patients after short-term surgical missions found the tool as cost-effective and reliable.…”