AEGiS-14IAC: The cost-effectiveness of the Zambian ProTest Project: integrating voluntary counselling and testing with tuberculosis activities.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

The cost-effectiveness of the Zambian ProTest Project: integrating voluntary counselling and testing with tuberculosis activities.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. WeOrF1287)

Terris-Prestholt F, Kumaranayake L, Ginwalla R, Ayles H, Godfrey-Faussett P
London School of Hygiene and Tropical Medicine, London, United Kingdom

BACKGROUND: The Zambian ProTest project encouraged voluntary counselling and testing (VCT) as an entry point to integrate case management and prevention of HIV-related tuberculosis (TB). A key aim was to enhance collaboration between health services and community organisations. Core components of ProTest are co-ordination between existing HIV/TB activities, provision of VCT with TB preventive therapy (PT), outreach and clinical services for HIV-related illnesses (ProTest clinic). Other activities include youth friendly services, a hospice for terminally ill patients and home based care (HBC). The ProTest project has lead to a substantial increase in people presenting for VCT, and has improved care for people living with HIV. The cost-effectiveness for each activity for the 2 ProTest sites, Chawama and Matero, was estimated.

METHODS: Financial and economic costs were collected retrospectively from November 2000 to October 2001 from the providers' perspective using the ingredients-based approach. Costs for the start-up and implementation of ProTest activities were included, all research related costs were excluded. Project outcomes and effectiveness indicators were collected prospectively by project staff.

RESULTS: The total annual economic cost of co-ordinating all ProTest components was US$3189 and US$3504 in Chawama and Matero, reaching 3604 and 258 people, respectively. The cost-effectiveness of VCT was US$31-US$33 per person post-test counselled and the incremental cost-effectiveness of PT was US$17-US$24 per person completing the full 6-month course. A visit to the ProTest-clinic costs US$7-US$8. Both the hospice and HBC rely heavily on donations and volunteer time, leading to a 3-fold difference between financial and economic costs.

CONCLUSIONS: The additional cost of co-ordinating the services available to people with HIV and TB is very low, although the unit costs are highly dependant on the size of the VCT service.

Keywords: AEGIS, Tuberculosis, Counseling, Cost-Benefit Analysis, HIV Infections, Research Design, Costs and Cost Analysis, HIV Seropositivity, Greece, Human, economics

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WeOrF1287