Abstract
BackgroundAdherence is crucial for public health program effectiveness, though the benefits of increasing adherence must ultimately be weighed against the associated costs. We sought to determine the relationship between investment in community health worker (CHW) home visits and increased attendance at cervical cancer screening appointments in Cape Town, South Africa.Methodology/Principal FindingsWe conducted an observational study of 5,258 CHW home visits made in 2003–4 as part of a community-based screening program. We estimated the functional relationship between spending on these visits and increased appointment attendance (adherence). Increased adherence was noted after each subsequent CHW visit. The costs of making the CHW visits was based on resource use including both personnel time and vehicle-related expenses valued in 2004 Rand. The CHW program cost R194,018, with 1,576 additional appointments attended. Adherence increased from 74% to 90%; 55% to 87%; 48% to 77%; and 56% to 80% for 6-, 12-, 24-, and 36-month appointments. Average per-woman costs increased by R14–R47. The majority of this increase occurred with the first 2 CHW visits (90%, 83%, 74%, and 77%; additional cost: R12–R26).Conclusions/SignificanceWe found that study data can be used for program planning, identifying spending levels that achieve adherence targets given budgetary constraints. The results, derived from a single disease program, are retrospective, and should be prospectively replicated.
Highlights
Health programs aimed at diseases such as HIV/AIDS, tuberculosis, type 2 diabetes, hypertension, and cancer, require individuals to return repeatedly to sites of clinical care in order to be effective [1]
The mean time spent visiting each woman during a trip was 21.9 minutes. This implies that the 5,258 community health worker (CHW) visits conducted required 5,566 hours of CHW time driving throughout the community and visiting women in their homes
By evaluating the patterns of CHW visits and women’s subsequent attendance at their screening appointments, we found the vast majority of additional attendance (.95%) occurred with no more than 2 CHW visits per woman per appointment type, requiring approximately 60% or less of the cost of the unlimited CHW visit program
Summary
Health programs aimed at diseases such as HIV/AIDS, tuberculosis, type 2 diabetes, hypertension, and cancer, require individuals to return repeatedly to sites of clinical care in order to be effective [1]. As such programs generally have upfront costs and delayed benefits due to averted disease and death, interventions are undertaken to increase participation, return, and adherence to health recommendations [2]. We sought to determine the relationship between investment in community health worker (CHW) home visits and increased attendance at cervical cancer screening appointments in Cape Town, South Africa
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