A cost-effectiveness analysis of a home-based HIV counselling and testing intervention versus the standard (facility based) HIV testing strategy in rural South Africa

Tabana, Hanani ; Nkonki, Lungiswa ; Hongoro, Charles ; Doherty, Tanya ; Ekström, Anna Mia ; Naik, Reshma ; Zembe-Mkabile, Wanga ; Jackson, Debra ; Thorson, Anna (2015)

CITATION: Tabana, H., et al. 2015. A cost-effectiveness analysis of a home- based HIV counselling and testing intervention versus the standard (facility based) HIV testing strategy in rural South Africa. PLoS ONE, 10(8): 1-13, doi: 10.1371/journal.pone.0135048.

The original publication is available at http://journals.plos.org/plosone

Article

Introduction: There is growing evidence concerning the acceptability and feasibility of home-based HIV testing. However, less is known about the cost-effectiveness of the approach yet it is a critical component to guide decisions about scaling up access to HIV testing. This study examined the cost-effectiveness of a home-based HIV testing intervention in rural South Africa. Methods: Two alternatives: clinic and home-based HIV counselling and testing were compared. Costs were analysed from a provider’s perspective for the period of January to December 2010. The outcome, HIV counselling and testing (HCT) uptake was obtained from the Good Start home-based HIV counselling and testing (HBHCT) cluster randomised control trial undertaken in KwaZulu-Natal province. Cost-effectiveness was estimated for a target population of 22,099 versus 23,864 people for intervention and control communities respectively. Average costs were calculated as the cost per client tested, while cost-effectiveness was calculated as the cost per additional client tested through HBHCT. Results: Based on effectiveness of 37% in the intervention (HBHCT) arm compared to 16% in control arm, home based testing costs US$29 compared to US$38 per person for clinic HCT. The incremental cost effectiveness per client tested using HBHCT was $19. Conclusions: HBHCT was less costly and more effective. Home-based HCT could present a cost-effective alternative for rural ‘hard to reach’ populations depending on affordability by the health system, and should be considered as part of community outreach programs.

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