Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study

Abstract Background HIV assisted partner services (aPS), or provider notification and testing for sexual and injecting partners of people diagnosed with HIV, is shown to be safe, effective, and cost-effective and was scaled up within the national HIV testing services (HTS) program in Kenya in 2016. We estimated the costs of integrating aPS into routine HTS within an ongoing aPS scale-up project in western Kenya. Methods We conducted microcosting using the payer perspective in 14 facilities offering aPS. Although aPS was offered to both males and females testing HIV-positive (index clients), we only collected data on female index clients and their male sex partners (MSP). We used activity-based costing to identify key aPS activities, inputs, resources, and estimated financial and economic costs of goods and services. We analyzed costs by start-up (August 2018), and recurrent costs one-year after aPS implementation (Kisumu: August 2019; Homa Bay: January 2020) and conducted time-and-motion observations of aPS activities. We estimated the incremental costs of aPS, average cost per MSP traced, tested, testing HIV-positive, and on antiretroviral therapy, cost shares, and costs disaggregated by facility. Results Overall, the number of MSPs traced, tested, testing HIV-positive, and on antiretroviral therapy was 1027, 869, 370, and 272 respectively. Average unit costs per MSP traced, tested, testing HIV-positive, and on antiretroviral therapy were $34.54, $42.50, $108.71 and $152.28, respectively, which varied by county and facility client volume. The weighted average incremental cost of integrating aPS was $7,485.97 per facility per year, with recurrent costs accounting for approximately 90% of costs. The largest cost drivers were personnel (49%) and transport (13%). Providers spent approximately 25% of the HTS visit obtaining MSP contact information (HIV-negative clients: 13 out of 54 min; HIV-positive clients: 20 out of 96 min), while the median time spent per MSP traced on phone and in-person was 6 min and 2.5 hours, respectively. Conclusion Average facility costs will increase when integrating aPS to HTS with incremental costs largely driven by personnel and transport. Strategies to efficiently utilize healthcare personnel will be critical for effective, affordable, and sustainable aPS.

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The Cost-effectiveness of Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis and HIV Testing Strategies in High-risk Groups in India

Clinical Infectious Diseases ◽

10.1093/cid/ciz249 ◽

2019 ◽

Vol 70 (4) ◽

pp. 633-642 ◽

Cited By ~ 1

Author(s):

Pooyan Kazemian ◽

Sydney Costantini ◽

Nagalingeswaran Kumarasamy ◽

A David Paltiel ◽

Kenneth H Mayer ◽

...

Keyword(s):

Cost Effectiveness ◽

Hiv Testing ◽

Scale Up ◽

Cost Effective ◽

Status Quo ◽

Hiv Incidence ◽

Testing Strategies ◽

Preexposure Prophylaxis ◽

Immunodeficiency Virus ◽

The Cost

Abstract Background The human immunodeficiency virus (HIV) epidemic in India is concentrated among 3.1 million men who have sex with men (MSM) and 1.1 million people who inject drugs (PWID), with a mean incidence of 0.9–1.4 per 100 person-years. We examined the cost-effectiveness of both preexposure prophylaxis (PrEP) and HIV testing strategies for MSM and PWID in India. Methods We populated an HIV microsimulation model with India-specific data and projected clinical and economic outcomes of 7 strategies for MSM/PWID, including status quo; a 1-time HIV test; routine HIV testing every 3, 6, or 12 months; and PrEP with HIV testing every 3 or 6 months. We used a willingness-to-pay threshold of US$1950, the 2017 Indian per capita gross domestic product, to define cost-effectiveness. Results HIV testing alone increased life expectancy by 0.07–0.30 years in MSM; PrEP added approximately 0.90 life-years to status quo. Results were similar in PWID. PrEP with 6-month testing was cost-effective for both MSM (incremental cost-effectiveness ratio [ICER], $1000/year of life saved [YLS]) and PWID (ICER, $500/YLS). Results were most sensitive to HIV incidence. PrEP with 6-month testing would increase HIV-related expenditures by US$708 million (MSM) and US$218 million (PWID) over 5 years compared to status quo. Conclusions While the World Health Organization recommends PrEP with quarterly HIV testing, our analysis identifies PrEP with semiannual testing as the cost-effective HIV prevention strategy for Indian MSM and PWID. Since nationwide scale-up would require a substantial fiscal investment, areas of highest HIV incidence may be the appropriate initial targets for PrEP scale-up.

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Formative research to inform the development of a peer-led HIV self-testing intervention to improve HIV testing uptake and linkage to HIV care among adolescents, young people and adult men in Kasensero fishing community, Rakai, Uganda: a qualitative study

BMC Public Health ◽

10.1186/s12889-020-09714-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Joseph K. B. Matovu ◽

Aminah Nambuusi ◽

Scovia Nakabirye ◽

Rhoda K. Wanyenze ◽

David Serwadda

Keyword(s):

Young People ◽

Hiv Testing ◽

Hiv Care ◽

Hiv Positive ◽

Fishing Community ◽

Adult Men ◽

Self Testing ◽

Testing Uptake ◽

Hiv Testing Services ◽

Linkage To Hiv Care

Abstract Background Despite efforts to improve HIV testing and linkage to HIV care among adolescents, young people and adult men, uptake rates remain below global targets. We conducted formative research to generate data necessary to inform the design of a peer-led HIV self-testing (HIVST) intervention intended to improve HIV testing uptake and linkage to HIV care in Kasensero fishing community in rural Uganda. Methods This qualitative study was conducted in three study communities in Kasensero fishing community in Rakai district, Uganda, in May 2019. Six single-sex focus group discussions (FGDs) comprising 7–8 participants were conducted with adolescents and young people (15–24 years) and adult men (25+ years). We collected data on people’s perceptions about peer-led HIVST; potential acceptability of a peer-led HIVST intervention and suggestions on how to improve linkage to HIV care after a positive HIVST result. Peer-led HIVST was defined as an approach where trained lay people distribute HIVST kits to other people in the community. FGDs were audio-recorded with permission from the participants, transcribed verbatim and analysed manually following a thematic framework approach. Results Forty-seven participants (31 men and 16 women) participated in the FGDs. Across communities and age-groups, most participants mentioned that peer-led HIVST would be generally acceptable to people in the fishing community but people will need support in performing the test due to fear of performing the test wrongly or failing to cope with HIV-positive results. Most participants felt that peer-led HIVST would bring HIV testing services closer to the community “because [the peer-leader] could be my immediate neighbour”, making it easier for people to obtain the kits at any time of their convenience. To improve linkage to HIV care, participants felt that the use of peer-leaders to deliver the initial ART dose to self-tested HIV-positive individuals would be more preferable to the use of community-based ART groups or home-based ART initiation. Conclusion Our study shows that peer-led HIVST is potentially acceptable in the fishing community. These findings suggest that this approach can improve uptake of HIV testing and linkage to HIV care services among populations that are usually missed through conventional HIV testing services.

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Accessing antiretroviral therapy for children: Caregivers' voices

Health SA Gesondheid ◽

10.4102/hsag.v21i0.987 ◽

2016 ◽

Vol 21 ◽

pp. 331-338

Author(s):

Margaret Williams ◽

Dalena R.M. Van Rooyen ◽

Esmeralda J. Ricks

Keyword(s):

Antiretroviral Therapy ◽

Tertiary Care ◽

Scale Up ◽

Target Population ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Positive ◽

Eastern Cape ◽

Care Facilities ◽

Sub Saharan

Despite efforts to scale up access to antiretroviral therapy (ART), particularly at primary health care (PHC) facilities, antiretroviral therapy (ART) continues to be out of reach formany human immunodeficiency virus (HIV)-positive children in sub-Saharan Africa. In resource limited settings decentralisation of ART is required to scale up access to essential medication. Traditionally, paediatric HIV care has been provided in tertiary care facilities which have better human and material resources, but limited accessibility in terms of distance for caregivers of HIV-positive children. The focus of this article is on the experiences of caregivers whilst accessing ART for HIV-positive children at PHC (decentralised care) facilities in Nelson Mandela Bay (NMB) in the Eastern Cape, South Africa. A qualitative, explorative, descriptive and contextual research design was used. The target population comprised caregivers of HIV-positive children. Data were collected by means of indepth individual interviews, which were thematically analysed. Guba's model was usedto ensure trustworthiness. Barriers to accessing ART at PHC clinics for HIV-positive children included personal issues, negative experiences, lack of support and finance, stigma and discrimination. The researchers recommend standardised programmes be developed and implemented in PHC clinics to assist in providing treatment, care and support for HIV positive children.

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Where Are the Newly Diagnosed HIV Positives in Kenya? Time to Consider Geo-Spatially Guided Targeting at a Finer Scale to Reach the “First 90”

Frontiers in Public Health ◽

10.3389/fpubh.2021.503555 ◽

2021 ◽

Vol 9 ◽

Author(s):

Anthony Waruru ◽

Joyce Wamicwe ◽

Jonathan Mwangi ◽

Thomas N. O. Achia ◽

Emily Zielinski-Gutierrez ◽

...

Keyword(s):

Hiv Testing ◽

Scan Statistics ◽

Rank Test ◽

Hiv Positive ◽

Newly Diagnosed ◽

Hiv Status ◽

Aggregated Data ◽

Hiv Testing Services ◽

Facility Level ◽

Global And Local

Background: The UNAIDS 90-90-90 Fast-Track targets provide a framework for assessing coverage of HIV testing services (HTS) and awareness of HIV status – the “first 90.” In Kenya, the bulk of HIV testing targets are aligned to the five highest HIV-burden counties. However, we do not know if most of the new HIV diagnoses are in these five highest-burden counties or elsewhere.Methods: We analyzed facility-level HTS data in Kenya from 1 October 2015 to 30 September 2016 to assess the spatial distribution of newly diagnosed HIV-positives. We used the Moran's Index (Moran's I) to assess global and local spatial auto-correlation of newly diagnosed HIV-positive tests and Kulldorff spatial scan statistics to detect hotspots of newly diagnosed HIV-positive tests. For aggregated data, we used Kruskal-Wallis equality-of-populations non-parametric rank test to compare absolute numbers across classes.Results: Out of 4,021 HTS sites, 3,969 (98.7%) had geocodes available. Most facilities (3,034, 76.4%), were not spatially autocorrelated for the number of newly diagnosed HIV-positives. For the rest, clustering occurred as follows; 438 (11.0%) were HH, 66 (1.7%) HL, 275 (6.9%) LH, and 156 (3.9%) LL. Of the HH sites, 301 (68.7%) were in high HIV-burden counties. Over half of 123 clusters with a significantly high number of newly diagnosed HIV-infected persons, 73(59.3%) were not in the five highest HIV-burden counties. Clusters with a high number of newly diagnosed persons had twice the number of positives per 1,000,000 tests than clusters with lower numbers (29,856 vs. 14,172).Conclusions: Although high HIV-burden counties contain clusters of sites with a high number of newly diagnosed HIV-infected persons, we detected many such clusters in low-burden counties as well. To expand HTS where most needed and reach the “first 90” targets, geospatial analyses and mapping make it easier to identify and describe localized epidemic patterns in a spatially dispersed epidemic like Kenya's, and consequently, reorient and prioritize HTS strategies.

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Initiation of antiretroviral therapy at rural primary health care clinics in KwaZulu Natal

Health SA Gesondheid ◽

10.4102/hsag.v18i1.658 ◽

2013 ◽

Vol 18 (1) ◽

Author(s):

Hilda Ganesen-Moothusamy ◽

Mergan Naidoo

Keyword(s):

Health Care ◽

Primary Health Care ◽

Antiretroviral Therapy ◽

Hepatitis B ◽

Medical Care ◽

Hiv Testing ◽

Hiv Positive ◽

Art Initiation ◽

Primary Health ◽

Kwazulu Natal

South Africa bears the greatest burden of HIV infection globally with the most infected people living in KwaZulu-Natal (KZN). Decentralised medical care for HIV positive patients and antiretroviral therapy (ART) delivery to primary health care facilities were proposed nationally to achieve adequate ART coverage for patients in need of treatment. This study described the HIV positive patients who accessed medical care and were initiated on ART at two existing government Primary Health Care (PHC) clinics with no added donor support, in Ilembe, KZN. This was an observational descriptive study of ART initiation from 01 April 2008 to 30 April 2009. Data were collected from clinical records kept on site. HIV Testing and the pre-ART programmes which consisted of medical care prior to ART initiation are briefly described. Socio-economic, demographic and clinical characteristics of patients who were initiated on ART were sampled and described. A minority (2.95%) of the study population tested for HIV of which 36.0% tested positive. Majority (60.0%) of patients who joined the pre-ART programme care did not return. The ART sample consisted of 375 patients of whom 65.0% were women, 85.9% were unmarried, 61.6% were unemployed and 50.4% had a secondary level of education. Tuberculosis (TB) prevalence and incidence at ART initiation were 22.1% and 14.7% respectively. The prevalence of Syphilis and Hepatitis B co-infections were 13.1% and 8.6 % respectively. Two thirds of female patients (66.4%) received a Pap smear result of which the majority (62.3%) were abnormal. Uptake for HIV testing followed by relevant CD4 testing was poor. High TB, Hepatitis B and Syphilis co-infection was noted amongst patients initiated on ART. Cervical cancer screening must be intensified. Although ART initiation with no added external resources was successful, record keeping was suboptimal.Suid-Afrika dra die grootste las van MIV-infeksie ter wêreld met die meeste besmette mense in KwaZulu-Natal (KZN). Gedesentraliseerde mediese sorg vir MIV-positiewe pasiënte en dienslewering van antiretrovirale terapie (ART) aan primêre gesondheidsorg- fasiliteite is nasionaal voorgestel om optimale ART-behandeling aan behoeftige te verskaf. Hierdie studie beskryf MIV-positiewe pasiënte wat ART-behandeling ontvang by twee bestaande Primêre Gesondheidsorgklinieke (PGS) in Ilembe, KZN sonder enige bykomende skenkerondersteuning. Waarnemingstegnieke is in die studie gebruik om ART-bekendstelling van 01 April 2008 tot 30 April 2009 te bestudeer. Data van kliniese rekords wat op die perseel gehou is, is ingesamel. MIV-toetsing en mediese behandelingsprogramme voor die bekendstelling van ART word kortliks beskryf. Sosio-ekonomiese, demografiese en kliniese eienskappe van pasiënte wat aan ART bekendgestel is, is versamel en beskryf. Minimum (2.95%) respondente aan die studie is vir MIV getoets, waarvan 36.0% positief getoets het. Die Meerderheid (60.0%) van pasiënte wat by die voorafgaande ART-sorgprogram aangesluit het, het nie terugkeer nie. Die ART-steekproef het bestaan uit 375 pasiënte waarvan 65.0% vroue was, 85.9% was ongetroud, 61.6% was werkloos en 50.4% het ’n sekondêre vlak van onderwys gehad. Die bestaan (reeds onder behandeling) en voorkoms (diagnose tydens bekendstelling van die ART-program) van Tuberkulose (TB) tydens ART-bekendstelling was 22.1% en 14.7% onderskeidelik. Die voorkoms van sifilis- en hepatitis B-infeksies was 13.1% en 8.6% onderskeidelik. Twee derdes van die vroulike pasiënte (66.4%) het ’n Papsmeer ondergaan, waarvan die meerderheid (62.3%) se uitslae abnormaal was. Die begrip vir MIV-toetsing gevolg deur toepaslike CD4-toetsing was swak. Hoë TB-, Hepatitis B- en sifilisinfeksies was by pasiënte aangeteken wat met ART-behandeling begin het. Ondersoeke vir servikale kanker moet verhoog word. Hoewel die ART-bekendstelling met geen toegevoegde eksterne hulpbronne suksesvol was, was rekordhouding nie optimaal nie.

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Using repeated home-based HIV testing services to reach and diagnose HIV infection among persons who have never tested for HIV, Chókwè health demographic surveillance system, Chókwè district, Mozambique, 2014–2017

PLoS ONE ◽

10.1371/journal.pone.0242281 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242281

Author(s):

Carol Lin ◽

Isabelle Casavant ◽

Alicia Jaramillo ◽

Timothy Green

Keyword(s):

Hiv Infection ◽

Hiv Testing ◽

Surveillance System ◽

Hiv Prevalence ◽

Demographic Surveillance System ◽

Hiv Positive ◽

Home Based ◽

Testing Uptake ◽

Hiv Testing Services ◽

Testing Coverage

Background HIV prevalence in Mozambique (12.6%) is one of the highest in the world, yet ~40% of people living with HIV (PLHIV) do not know their HIV status. Strategies to increase HIV testing uptake and diagnosis among PLHIV are urgently needed. Home-based HIV testing services (HBHTS) have been evaluated primarily as a 1-time campaign strategy. Little is known about the potential of repeating HBHTS to diagnose HIV infection among persons who have never been tested (NTs), nor about factors/reasons associated with never testing in a generalized epidemic setting. Methods During 2014–2017, counselors visited all households annually in the Chókwè Health and Demographic Surveillance System (CHDSS) and offered HBHTS. Cross-sectional surveys were administered to randomly selected 10% or 20% samples of CHDSS households with participants aged 15–59 years before HBHTS were conducted during the visit. Descriptive statistics and logistic regression were used to assess the proportion of NTs, factors/reasons associated with never having been tested, HBHTS acceptance, and HIV-positive diagnosis among NTs. Results The proportion of NTs decreased from 25% (95% confidence interval [CI]:23%–26%) during 2014 to 12% (95% CI:11% –13%), 7% (95% CI:6%–8%), and 7% (95% CI:6%–8%) during 2015, 2016, and 2017, respectively. Adolescent boys and girls and adult men were more likely than adult women to be NTs. In each of the four years, the majority of NTs (87%–90%) accepted HBHTS. HIV-positive yield among NTs subsequently accepting HBHTS was highest (13%, 95% CI:10%–15%) during 2014 and gradually reduced to 11% (95% CI:8%–15%), 9% (95% CI:6%–12%), and 2% (95% CI:0%–4%) during 2015, 2016, and 2017, respectively. Conclusions Repeated HBHTS was helpful in increasing HIV testing coverage and identifying PLHIV in Chókwè. In high HIV-prevalence settings with low testing coverage, repeated HBHTS can be considered to increase HIV testing uptake and diagnosis among NTs.

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Implementing Assisted Partner Services to HIV Test and Treat Men and their Female Sexual Partners: A Study Protocol (Preprint)

10.2196/preprints.27262 ◽

2021 ◽

Author(s):

Edward Kariithi ◽

Monisha Sharma ◽

Emily Kemunto ◽

Harison Lagat ◽

George Otieno ◽

...

Keyword(s):

Hiv Testing ◽

Real World ◽

Sexual Partners ◽

Hiv Positive ◽

Newly Diagnosed ◽

Western Kenya ◽

Hiv Testing Services ◽

Male Sexual Partners ◽

Female Index

BACKGROUND Despite the effective scale-up of HIV testing and treatment programs worldwide, only 75% of persons living with HIV (PLWH) globally know their status, with lower rates among men. This highlights the importance of implementing HIV testing and linkage interventions with high uptake in this population group. In a cluster randomized controlled trial conducted between 2013 and 2015, our team found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH, safely reached more at-risk individuals to conduct testing compared to client referral alone. However, more data is needed to assess APS implementation in a real-world setting. OBJECTIVE This study evaluates the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya. METHODS In a collaboration between the University of Washington and PATH, we are integrating APS into 31 health facilities in Western Kenya and enrolling female index clients newly diagnosed with HIV who receive APS, their male sexual partners, and female sexual partners of the male sexual partners who test HIV positive. Female index clients and all sexual partners testing HIV-positive will be followed up at 6 weeks, 6 months, and 12 months to assess linkage to care, antiretroviral therapy (ART) initiation, and HIV viral load suppression. We will evaluate acceptability, fidelity and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and sub-county level policymakers responsible for HIV testing services. Facility health staff providing HIV testing services and APS, in addition to staff working with the study project team will also be interviewed. We will also conduct direct observations of facility infrastructure and clinic procedures, and extract data from facility and county/national databases. RESULTS As of March 2020, we have recruited 1724 index clients, 3201 male partners, and 1585 female partners. We have completed all recruitment for this study and have completed all 6-week (99%), 6-month (97%) and 12-month (91%) follow-up visits. Preliminary analyses demonstrate that through scaling-up APS, facilities are able to identify 12-18 new HIV-positive males for every 100 men contacted and tested. We are now in the process of completing the remaining follow-up interviews and building a self-testing component of the study as an adaptation to the COVID-19 pandemic. CONCLUSIONS Results will be used to bridge the gap between clinical research findings and everyday practice, and provide guidance on optimal strategies for APS integration into HIV service delivery. CLINICALTRIAL N/A

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Perceptions of Human Immunodeficiency Virus (HIV) Testing Services Among HIV-Positive Persons Not in Medical Care

Sexually Transmitted Diseases ◽

10.1097/01.olq.0000156132.19021.ba ◽

2005 ◽

Vol 32 (4) ◽

pp. 207-213 ◽

Cited By ~ 13

Author(s):

Ellen T. Rudy ◽

Pamela J. Mahoney-Anderson ◽

Anita M. Loughlin ◽

Lisa R. Metsch ◽

Peter R. Kerndt ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Medical Care ◽

Hiv Testing ◽

Hiv Positive ◽

Immunodeficiency Virus ◽

Hiv Testing Services

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The effect of counseling, antiretroviral therapy and relationship on disclosing HIV positive status to sexual partner among adult HIV patients in Ethiopia: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0249887 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249887

Author(s):

Melaku Yalew ◽

Bezawit Adane ◽

Bereket Kefale ◽

Yitayish Damtie ◽

Sisay Eshete Tadesse ◽

...

Keyword(s):

Systematic Review ◽

Antiretroviral Therapy ◽

Hiv Testing ◽

Sexual Partner ◽

Meta Analysis ◽

Hiv Positive ◽

Hiv Status ◽

Hiv Patients ◽

Link Type ◽

The Government

Background Human Immunodeficiency Virus (HIV) is continued as a major public health problem, especially in developing countries. Therefore, this study aimed to estimate the effect of counseling, antiretroviral therapy (ART) and relationship on disclosing HIV positive status to sexual partner among adult HIV patients in Ethiopia. Methods The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was used during this review. The study included both published and unpublished studies which were conducted in Ethiopia until the end of 2019. Different electronic databases (PubMed, Cochrane library, CINAHL, Global Health, HINARI and Google scholar) were searched. Data were extracted in Microsoft Excel sheet and STATA/SE 14 was used to meta-analysis. I2 and Egger test statistics were used to test heterogeneity and publication bias respectively. Results Twenty-two articles with 8,873 adult HIV infected peoples were included in this systematic review and meta-analysis. The pooled magnitude of disclosing HIV status to sexual partner was 74.63% [95% CI: (67.79, 81.47)]. Counseled [AOR = 4.96, 95% CI: (2.87, 8.55)], ART initiated [AOR = 4.78, 95% CI: (3.84, 5.94)] and who had a smooth relationship before HIV testing [AOR = 6.82, 95% CI: (3.49, 13.33)] were significantly associated with disclosing HIV status to sexual partner. Conclusions Disclosing HIV positive status to sexual partner in Ethiopia was low as the government invested in partner notification. Counseling, ART initiation and smooth relationship before HIV testing were significantly associated with disclosing HIV status to sexual partner. The government needs to strengthen pre and post HIV test counseling even after treatment started to increase disclosing status. Registration The protocol of this systematic review and meta-analysis was registered in the PROSPERO with a specific registration number: CRD42020161276; https://clinicaltrials.gov/.

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