16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

COMPARATIVE EVALUATION OF DIFFERENT APPROACHES OF VOLUNTARY COUNSELING AND TESTING (VCT) IN TANZANIA: UPTAKE, QUALITY, AND COSTS

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. TuAc0104

M. Péchevis¹, P. Urassa², K. Lema³, G. Mbekem³, M.-L. Kürzinger¹, A. Reeler¹, J.F. Richardson⁴, R. Swai², J.G. Kahn⁵, E. Lugada^6
1 Axios International, Paris, France, ² National AIDS control program, Dar es Salaam, Tanzania, United Republic of, ³ Axios Foundation, Dar es Salaam, Tanzania, United Republic of, ⁴ Abbott Laboratories Fund, Washington DC, United States, ⁵ University of California San Francisco, Institute for Health Policy, San Francisco, United States, ⁶ Axios Foundation, Dar Es Salaam, Tanzania, United Republic of

BACKGROUND: Voluntary Counseling and Testing (VCT) is a mainstay of HIV/AIDS prevention and treatment. However, most individuals have not been tested. In Africa, VCT is offered mainly at stand-alone centers, which can be free-standing or health facilty based, but not integrated into health services, where attendees have higher HIV prevalence. The Tanzanian government, with technical support from Axios and funding from the Abbott Fund, is implementing an integrated VCT program in 12 regions with testing offered during routine outpatient services. This study compares integrated and stand alone VCT, with the hope of informing VCT strategies in sub-Saharan Africa. Specific objectives are to assess uptake, quality, and costs.

METHODS: This was a multi-center, comparative evaluation of integrated and stand alone VCT centers in selected districts in Tanzania. Uptake rates (completion of VCT among clients receiving pre-test counselling) were calculated from program monitoring data. Quality of services was assessed through staff and client interviews. Unit costs were determined from program expenditure records, interviews and on-site observations. Main outcome measures were VCT initiation and follow-up, quality of services, costs per person tested, per HIV infection identified and per HIV infection averted.

RESULTS: In 2005, 25,533 patients were counseled at primary care health facilities offering integrated VCT in four districts. Uptake was: 25,398 accepted testing (99.5%), and 25,354 received results (99.3%). There were no differences across facilities. 4,908 patients (19.3%) tested HIV positive. The prevalence rates in dispensaries, health centers, district hospitals were, respectively, 15.2%, 18.1%, and 27.8% (p<0.001). Analogous results will be presented for stand-alone VCT centers. We will also present quality and costs for the two models.

CONCLUSIONS: Integrated VCT can contribute effectively to detection of HIV cases because patients attending health facilities have a higher chance of being HIV-infected. In addition, the linkage to care and ARVs is strengthened.

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2006-08-13
TuAc0104

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