HIV partner services in Kenya: a cost and budget impact analysis study.

BMC Health Serv Res 2018 Sep 17;18(1):721. Epub 2018 Sep 17.

Department of Global Health, University of Washington, Seattle, WA, USA.

Background: The elicitation of contact information, notification and testing of sex partners of HIV infected patients (aPS), is an effective HIV testing strategy in low-income settings but may not necessarily be affordable. We applied WHO guidelines and the International Society for Pharmaco-economics and Outcomes Research (ISPOR) guidelines to conduct cost and budget impact analyses, respectively, of aPS compared to current practice of HIV testing services (HTS) in Kisumu County, Kenya.

Methods: Using study data and time motion studies, we constructed an Excel-based tool to estimate costs and the budget impact of aPS. Cost data were collected from selected facilities in Kisumu County. We report the annual total and unit costs of HTS, incremental total and unit costs for aPS, and the budget impact of scaling up aPS over a 5-year horizon. We also considered a task-shifted scenario that used community health workers (CHWs) rather than facility based health workers and conducted sensitivity analyses assuming different rates of scale up of aPS.

Results: The average unit costs for HIV testing among HIV-infected index clients was US$ 25.36 per client and US$ 17.86 per client using nurses and CHWs, respectively. The average incremental costs for providing enhanced aPS in Kisumu County were US$ 1,092,161 and US$ 753,547 per year, using nurses and CHWs, respectively. The average incremental cost of scaling up aPS over a five period was 45% higher when using nurses compared to using CHWs (US$ 5,460,837 and US$ 3,767,738 respectively). Over the five years, the upper-bound budget impact of nurse-model was US$ 1,767,863, 63% and 35% of which were accounted for by aPS costs and ART costs, respectively. The CHW model incurred an upper-bound incremental cost of US$ 1,258,854, which was 71.2% lower than the nurse-based model. The budget impact was sensitive to the level of aPS coverage and ranged from US$ 28,547 for 30% coverage using CHWs in 2014 to US$ 1,267,603 for 80% coverage using nurses in 2018.

Conclusion: Scaling aPS using nurses has minimal budget impact but not cost-saving over a five-year period. Targeting aPS to newly-diagnosed index cases and task-shifting to community health workers is recommended.

Download full-text PDF

Source
https://bmchealthservres.biomedcentral.com/articles/10.1186/
Publisher Site
http://dx.doi.org/10.1186/s12913-018-3530-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142360PMC
September 2018
44 Reads

Publication Analysis

Top Keywords

budget impact
28
unit costs
12
hiv testing
12
kisumu county
12
scaling aps
12
health workers
12
aps
11
us$
10
chws average
8
nurses chws
8
community health
8
average incremental
8
incremental cost
8
total unit
8
cost budget
8
costs
7
impact
7
budget
7
cost
5
hiv
5

References

(Supplied by CrossRef)

P Cherutich et al.
Lancet HIV 2017

LB Brown et al.
J Acquir Immune Defic Syndr 2011

C Henley et al.
Sex Transm Dis 2013

SE Rutstein et al.
Health Policy Plan 2014

M Sharma et al.
AIDS 2018

SD Sullivan et al.
Value Health 2014

WG Goettsch et al.
Value Health 2014

DO Kimanga et al.
J Acquir Immune Defic Syndr 2014

A Ng'ang'a et al.
J Acquir Immune Defic Syndr 2014

Similar Publications