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

Peter Cherutich,Paul Macharia,Carey Farquhar,Beatrice Wamuti,Felix A Otieno,David Bukusi,Peter Maingi Mutiti,Carol Levin,Betsy Sambai,Ann Ng’Ang’A

doi:10.1186/s12913-018-3530-y

Abstract

BackgroundThe 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.MethodsUsing 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.ResultsThe 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.ConclusionScaling 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.

Highlights

The elicitation of contact information, notification and testing of sex partners of Human immuno-deficiency syndrome (HIV) infected patients, is an effective HIV testing strategy in low-income settings but may not necessarily be affordable
The total cost of HIV testing per index client varied across the three levels of health facilities, and by HIV status of sex partners of index cases
Using community health workers (CHW), the cost of a similar HIV test was US$ 5.6 per client when performed in a hospital for HIV-negative patients and US$ 62.8 per client for an HIV-infected case when conducted in the lowest level clinic

Summary

Introduction

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. Assisted partner services (aPS), the systematic elicitation of contact information, exposure notification and active locating of sex partners of HIV infected patients, is essential for HIV prevention.

Methods

Results

Conclusion