Increasing Access to HIV Counseling and Testing Through Mobile Services in Kenya: Strategies, Utilization, and Cost-Effectiveness

Abstract

This study compares client volume, demographics, testing results and costs of three ‘mobile’ HIV counseling and testing (HCT) approaches with existing ‘stand-alone’ HCT in Kenya. A retrospective cohort of 62,173 individuals receiving HCT between May 2005 and April 2006, was analyzed. Mobile HCT approaches assessed were community-site mobile HCT, semi-mobile container HCT, and fully mobile truck HCT. Data were obtained from project monitoring data, project accounts and personnel interviews. Results Mobile HCT reported a higher proportion of clients with no prior HIV test than stand-alone (88% vs. 58%). Stand-alone HCT reported a higher proportion of couples than mobile HCT (18% vs. 2%), and a higher proportion of discordant couples (12% vs. 4%). The incremental cost-effectiveness of adding mobile HCT to stand-alone services was $14.91 per client tested (vs. $26.75 for stand-alone HCT); $16.58 per previously untested client (vs. $43.69 for stand-alone HCT); and $157.21 per HIV-positive individual identified (vs. $189.14 for stand-alone HCT). Conclusions Adding mobile HCT to existing stand-alone HCT appears to be a cost-effective approach for expanding HCT coverage, for reaching different target populations, including women and young people, and for identifying persons with newly diagnosed HIV infection for referral to treatment and care.

From caution to urgency: the evolution of HIV testing and counselling in Africa

“…48 There is a rationale, therefore, for considering and evaluating household or community-based testing in addition to expanding PITC. 49 Data on these alternative approaches would help identify the most effective and appropriate way of implementing HIV testing in specific local contexts, while taking into account the resources available and social constraints. ■…”

Perceptions of door-to-door HIV counselling and testing in Botswana

“…In recent years, increased demand for HIV testing in response to availability and rapid scale-up of antiretroviral therapy, and the advent of rapid HIV testing technology, have prompted the development of multiple models that include provider-initiated HIV testing as the standard of care in clinical settings, and streamlined counselling protocols for high-volume, resourcelimited settings (Grabbe, Menzie, Taegtmeyer, Emulkule, Angala, Mwega et al, 2010;Marum, Taegtmeyer, & Chebet, 2006;Menzies, Abang, Wanyenze, Nuwaha, Mugisha, Coutinho et al, 2009;Liechty, 2005). Rapid HIV testing has been an important development because it can be carried out in non-clinical settings and facilitates same-day delivery of test results (Greenwald, Burstein, Pincus and Branson, 2006;Hutchinson, Branson, Kim and Farnham, 2006), enabling many more HIV-positive persons to become aware of their status and be linked to needed care and support services (Matovu & Makumbi, 2007;Helleringer S, Kohler H, Frimpong J & Mkandawire J, 2009).…”

Costs and cost–effectiveness of HIV community services: quantity and quality of studies published 1986–2011

“…250 [89] Provision of ART Home-based care 2167-5039 [44,70] 1061 (ppy) [42] 17,575 [51] Primary health clinic…”