Optimising the cost and delivery of HIV counselling and testing services in Kenya and Swaziland
Optimising the cost and delivery of HIV counselling and testing services in Kenya and Swaziland
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DOI：
10.1136/sextrans-2012-050544
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发表时间：
2012-11-01
影响因子：
3.6
通讯作者：
Watts, Charlotte
中科院分区：
文献类型：
--
作者：
Obure, Carol Dayo;Vassall, Anna;Watts, Charlotte
背景在低资源高艾滋病毒流行率环境中，艾滋病毒咨询和检测（HCT）的方法多年来已经从主要由客户发起的方法转变为由提供者发起的方法。作为一个正在进行的计划科学研究议程的一部分，我们研究提供者发起的检测和咨询（PITC）服务的相对成本相比，自愿咨询和检测（VCT）服务在同一卫生设施在两个低资源的设置：肯尼亚和斯威士兰。每年的总成本和平均成本每客户咨询和测试（C&T），并确定HIV阳性的客户，estimated.Results VCT仍然是主要的模式，在这两个国家的HCT服务提供。然而，在肯尼亚所有类型的设施中，PITC的每名客户C&T和每名艾滋病毒检测阳性者的单位成本低于VCT，但斯威士兰的情况好坏参半。在肯尼亚，每名客户的C&T平均成本为4.81美元至6.11美元，在斯威士兰，PITC的平均成本为6.92美元至13.51美元，在肯尼亚和斯威士兰，VCT的平均成本分别为5.05美元至16.05美元和8.68美元至19.32美元。这项研究表明，在肯尼亚和斯威士兰提供HCT服务的效率可能会有实质性的提高。然而，在考虑如何有效地提供服务时，需要考虑到当地的具体情况，如普遍程度、服务需求和人力资源的可用性。
Background Approaches to HIV counselling and testing (HCT) within low-resource high HIV prevalence settings have shifted over the years from primarily client-initiated approaches to provider initiated. As part of an ongoing programme science research agenda, we examine the relative costs of provider-initiated testing and counselling (PITC) services compared with voluntary counselling and testing (VCT) services in the same health facilities in two low-resource settings: Kenya and Swaziland.Methods Annual financial and economic costs and output measures were collected retrospectively from 28 health facilities. Total annual costs and average costs per client counselled and tested (C&T), and HIV-positive clients identified, were estimated.Results VCT remains the predominant mode of HCT service delivery across both countries. However, unit cost per client C&T and per person testing HIV positive is lower for PITC than VCT across all facility types in Kenya, but the picture is mixed in Swaziland. Average cost per client C&T ranged from US$4.81 to US$6.11 in Kenya, US$6.92 to US$13.51 in Swaziland for PITC, and from US $5.05 to US$16.05 and US$8.68 to US$19.32 for VCT in Kenya and Swaziland, respectively.Conclusions In the context of significant policy interest in optimising scarce HIV resources, this study demonstrates that there may be potential for substantial gains in efficiency in the provision of HCT services in both Kenya and Swaziland. However, considerations of how to deliver services efficiently need to be informed by local contextual factors, such as prevalence, service demand and availability of human resources.