P09.17 LB
Background: Community based HIV testing and counseling (HTC) and linkage to HIV care has demonstrated high effectiveness. However, HTC program costs are needed to inform policy decisions.
Methods: We estimated costs of mobile clinic and home-based HTC with point-of-care (POC) CD4 testing and counselor follow up at home to encourage linkage. Costs were collected in KwaZulu-Natal in 2013 from the Linkages Study, a randomized trial of community HTC and linkage to care. Time and motion studies were conducted to separate research from program activities. Costs were obtained from budgets, invoices and staff interviews. We assumed task shifting from nurses to community workers. Program effectiveness was estimated from our pilot study in a nearby area (N = 1272, 30% HIV prev). Total program costs for HIV+ persons were divided by number virally suppressed at 12 mos to estimate incremental cost per person virally suppressed.
Results: Program cost of mobile HTC was $5.45 per HIV- person tested and $8.28 per HIV+ tested. POC CD4 increased cost per HIV+ tested to $14.78 and POC with follow-up cost $21.78. Home HTC cost $8.22 and $12.13 per HIV- and HIV+ person tested. Using effectiveness from our prior study (32% of HIV+ persons were ART eligible at CD4≤ 350 mL, of whom 69% initiated ART and 70% virally suppressed at 12 mos), incremental cost for all HIV+ persons for home HTC with POC CD4 and counselor follow up was $126.10 per person linked to care and $179.19 per person virally suppressed. Mobile HTC with POC CD4 and follow-up cost $96.62 and $137.30 per person linked to care and virally suppressed. Assuming similar program effectiveness under the new ART guidelines of eligibility at CD4≤ 500 mL, costs would decrease to $100.95 and $77.35 per person virally suppressed through home and mobile HTC respectively.
Conclusions: Community HTC with POC CD4 and follow-up achieves high linkage and viral suppression at costs of $137–179 per HIV+ person virally suppressed. Incremental costs are expected to decrease with new ART guidelines.
