Abstract
Integrating POC CD4 testing technologies into HIV counseling and testing (HCT) programs may improve post-HIV testing linkage to care and treatment. As evaluations of these technologies in program settings continue, estimates of the costs of POC CD4 tests to the service provider will be needed and estimates have begun to be reported. Without a consistent and transparent methodology, estimates of the cost per CD4 test using POC technologies are likely to be difficult to compare and may lead to erroneous conclusions about costs and cost-effectiveness. This paper provides a step-by-step approach for estimating the cost per CD4 test from a provider's perspective. As an example, the approach is applied to one specific POC technology, the Pima™ Analyzer. The costing approach is illustrated with data from a mobile HCT program in Gauteng Province of South Africa. For this program, the cost per test in 2010 was estimated at $23.76 (material costs = $8.70; labor cost per test = $7.33; and equipment, insurance, and daily quality control = $7.72). Labor and equipment costs can vary widely depending on how the program operates and the number of CD4 tests completed over time. Additional costs not included in the above analysis, for on-going training, supervision, and quality control, are likely to increase further the cost per test. The main contribution of this paper is to outline a methodology for estimating the costs of incorporating POC CD4 testing technologies into an HCT program. The details of the program setting matter significantly for the cost estimate, so that such details should be clearly documented to improve the consistency, transparency, and comparability of cost estimates.
Highlights
In most resource-limited countries, eligibility for antiretroviral therapy (ART) for HIV/AIDS is based on a count of CD4+ Tlymphocytes
Staff time per test (Table 2) If POC CD4 testing is integrated into HIV counseling and testing (HCT) programs, providing this service requires additional time of HCT staff members
As studies continue to assess the usefulness of POC CD4 testing for improving patient care and strengthening linkage to care and treatment after HIV testing, the cost of such tests will need to be estimated in a range of settings, including mobile HCT programs, fixed-site HCT programs attached to medical facilities, and those not attached to a medical facility
Summary
In most resource-limited countries, eligibility for antiretroviral therapy (ART) for HIV/AIDS is based on a count of CD4+ Tlymphocytes. Traditional CD4 count technologies require that a venous blood sample be processed by a laboratory. After testing positive for HIV infection, patients either provide a blood sample immediately or are referred to another facility if the HIV counseling and testing (HCT) site does not take blood samples. The blood sample is sent to a laboratory for processing. Results are typically available between 2 and 14 days after the patient has provided the sample. Patients are asked to return to the clinic to receive their results, after which they are referred for future HIV care and/or treatment
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