Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian ProTEST Initiative

Abstract

BackgroundIn the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH) in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT) acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC), and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy.MethodsAnnual financial and economic providers costs and output measures were collected in 2000–2001. Estimates are made of total costs for each component and average costs per: person reached by ProTEST; VCT pre-test counselled, tested and completed; isoniazid preventive therapy started and completed; clinic visit; HBC patient; and hospice admission and bednight.ResultsAnnual core ProTEST costs were (in 2007 US dollars) $84,213 in Chawama and $31,053 in Matero. The cost of coordination was 4%–5% of total site costs ($1–$6 per person reached). The largest cost component in Chawama was voluntary counselling and testing (56%) and the clinic in Matero (50%), where VCT clients had higher HIV-prevalences and more advanced HIV. Average costs were lower for all components in the larger site. The cost per HBC patient was $149, and per hospice bednight was $24.ConclusionThis study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

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

“…The cost per client tested for the home-based strategy was comparable to that (US$ 5.88 -8.29) reported in other studies [35][36][37] . Although the cost per client tested in the facility-based strategy reported here was higher than that of home-based VCT, it was lower than that reported elsewhere 31,36,38,39 . The level of care and range of services provided by a facility affects the costs and therefore contributes to the variation in costs observed.…”

Linkage to Care and Treatment for TB and HIV among People Newly Diagnosed with TB or HIV-Associated TB at a Large, Inner City South African Hospital

“…The Pro-TEST study in urban Zambia demonstrated that delivery of integrated services, including a strong referral system reduces patient costs and is financially feasible and inexpensive [17].…”

“…While treatment interruption during the course of TB treatment and antiretroviral treatment (ART) have been extensively studied [9]–[13], little is known about the linkage to care after the initial diagnosis [14], particularly among people diagnosed with HIV-associated TB at a hospital facility [15], [16]. Because the cost-effectiveness of diagnostic interventions is in part determined by successful linkage to care [17], [18], the rate of linkage to care should be monitored and evaluated along with other programmatic targets [18], [19]. Currently, rates of and reasons for failure to link TB and HIV diagnosis with care are not collected as part of routine monitoring and evaluation in TB and ART programs, making evidence-based decisions on how to improve linkage to care difficult [20].…”

Integrating HIV treatment with primary care outpatient services: opportunities and challenges from a scaled-up model in Zambia

“…2010) and tuberculosis (Harris et al . 2008; Terris-Prestholt et al . 2008), existing literature has paid far less attention to integration as it relates to service delivery at the primary level.…”