Abstract

BackgroundIn South Africa, the financing and sustainability of HIV services is a priority. Community-based HIV testing services (CB-HTS) play a vital role in diagnosis and linkage to HIV care for those least likely to utilise government health services. With insufficient estimates of the costs associated with CB-HTS provided by NGOs in South Africa, this cost analysis explored the cost to implement and provide services at two NGO-led CB-HTS modalities and calculated the costs associated with realizing key HIV outputs for each CB-HTS modality.MethodsThe study took place in a peri-urban area where CB-HTS were provided from a stand-alone centre and mobile service. Using a service provider (NGO) perspective, all inputs were allocated by HTS modality with shared costs apportioned according to client volume or personnel time. We calculated the total cost of each HTS modality and the cost categories (personnel, capital and recurring goods/services) across each HTS modality. Costs were divided into seven pre-determined project components, used to examine cost drivers. HIV outputs were analysed for each HTS modality and the mean cost for each HIV output was calculated per HTS modality.ResultsThe annual cost of the stand-alone and mobile modalities was $96,616 and $77,764 respectively, with personnel costs accounting for 54% of the total costs at the stand-alone. For project components, overheads and service provision made up the majority of the costs. The mean cost per person tested at stand-alone ($51) was higher than at the mobile ($25). Linkage to care cost at the stand-alone ($1039) was lower than the mobile ($2102).ConclusionsThis study provides insight into the cost of an NGO led CB-HTS project providing HIV testing and linkage to care through two CB-HIV testing modalities. The study highlights; (1) the importance of including all applicable costs (including overheads) to ensure an accurate cost estimate that is representative of the full service implementation cost, (2) the direct link between test uptake and mean cost per person tested, and (3) the need for effective linkage to care strategies to increase linkage and thereby reduce the mean cost per person linked to HIV care.

Highlights

  • In South Africa, the financing and sustainability of human immunodeficiency virus (HIV) services is a priority

  • Communitybased services can provide HIV testing: (1) on a mobile basis which can reach more men compared to facility-based services [10, 11]; (2) at stand-alone facilities, which have proportionately more clients who test HIV-positive compared to mobile services [12]; and (3) in the home, which reaches more first-time testers and males compared to mobile services [13]

  • Overall costs per cost category The overall annual cost of the Community-based HIV testing services (CB-HIV testing services (HTS)) delivered by the non-governmental organization (NGO) selected for this analysis was $174,380, with stand-alone costing $96,616 and mobile services $77,764

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Summary

Introduction

Community-based HIV testing services (CB-HTS) play a vital role in diagnosis and linkage to HIV care for those least likely to utilise government health services. There are limited data on population level of people aware of their HIV status – in one district in South Africa, it has been estimated that 48% of men and 35%of women are unaware that they are living with HIV [5]. HIV testing services (HTS) have a pivotal role to play in the pursuit of the first “90” by expanding the proportion of people living with HIV who know their status. Communitybased HIV testing services (CB-HTS) can reach populations who do not typically access health facilities, for example, males [7,8,9], making them a viable alternative to government-led facility-based services. Communitybased services can provide HIV testing: (1) on a mobile basis (using mobile vans and tents) which can reach more men compared to facility-based services [10, 11]; (2) at stand-alone facilities (fixed sites), which have proportionately more clients who test HIV-positive compared to mobile services [12]; and (3) in the home, which reaches more first-time testers and males compared to mobile services [13]

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