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A Cost-Effectiveness Analysis of a Home-Based HIV Counselling and Testing Intervention versus the Standard (Facility Based) HIV Testing Strategy in Rural South Africa

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Listed:
  • Hanani Tabana
  • Lungiswa Nkonki
  • Charles Hongoro
  • Tanya Doherty
  • Anna Mia Ekström
  • Reshma Naik
  • Wanga Zembe-Mkabile
  • Debra Jackson
  • Anna Thorson

Abstract

Introduction: There is growing evidence concerning the acceptability and feasibility of home-based HIV testing. However, less is known about the cost-effectiveness of the approach yet it is a critical component to guide decisions about scaling up access to HIV testing. This study examined the cost-effectiveness of a home-based HIV testing intervention in rural South Africa. Methods: Two alternatives: clinic and home-based HIV counselling and testing were compared. Costs were analysed from a provider’s perspective for the period of January to December 2010. The outcome, HIV counselling and testing (HCT) uptake was obtained from the Good Start home-based HIV counselling and testing (HBHCT) cluster randomised control trial undertaken in KwaZulu-Natal province. Cost-effectiveness was estimated for a target population of 22,099 versus 23,864 people for intervention and control communities respectively. Average costs were calculated as the cost per client tested, while cost-effectiveness was calculated as the cost per additional client tested through HBHCT. Results: Based on effectiveness of 37% in the intervention (HBHCT) arm compared to 16% in control arm, home based testing costs US$29 compared to US$38 per person for clinic HCT. The incremental cost effectiveness per client tested using HBHCT was $19. Conclusions: HBHCT was less costly and more effective. Home-based HCT could present a cost-effective alternative for rural ‘hard to reach’ populations depending on affordability by the health system, and should be considered as part of community outreach programs.

Suggested Citation

  • Hanani Tabana & Lungiswa Nkonki & Charles Hongoro & Tanya Doherty & Anna Mia Ekström & Reshma Naik & Wanga Zembe-Mkabile & Debra Jackson & Anna Thorson, 2015. "A Cost-Effectiveness Analysis of a Home-Based HIV Counselling and Testing Intervention versus the Standard (Facility Based) HIV Testing Strategy in Rural South Africa," PLOS ONE, Public Library of Science, vol. 10(8), pages 1-13, August.
    • Handle: RePEc:plo:pone00:0135048
    DOI: 10.1371/journal.pone.0135048
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    References listed on IDEAS

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    1. Kalpana Sabapathy & Rafael Van den Bergh & Sarah Fidler & Richard Hayes & Nathan Ford, 2012. "Uptake of Home-Based Voluntary HIV Testing in Sub-Saharan Africa: A Systematic Review and Meta-Analysis," PLOS Medicine, Public Library of Science, vol. 9(12), pages 1-14, December.
    2. Thielman, N.M. & Chu, H.Y. & Ostermann, J. & Itemba, D.K. & Mgonja, A. & Mtweve, S. & Bartlett, J.A. & Shao, J.F. & Crump, J.A., 2006. "Cost-effectiveness of free HIV voluntary counseling and testing through a community-based AIDS service organization in Northern Tanzania," American Journal of Public Health, American Public Health Association, vol. 96(1), pages 114-119.
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    Cited by:

    1. Gesine Meyer-Rath & Craig van Rensburg & Calvin Chiu & Rahma Leuner & Lise Jamieson & Steve Cohen, 2019. "The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-15, February.
    2. Jennifer A Gilbert & Sheela V Shenoi & Anthony P Moll & Gerald H Friedland & A David Paltiel & Alison P Galvani, 2016. "Cost-Effectiveness of Community-Based TB/HIV Screening and Linkage to Care in Rural South Africa," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-19, December.
    3. Arielle Lasry & Mireille B Kalou & Paul R Young & Jacqueline Rurangirwa & Bharat Parekh & Stephanie Behel, 2019. "Cost implications of HIV retesting for verification in Africa," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-15, July.

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