title: Cost-effectiveness of free HIV voluntary counseling and testing through a community-based AIDS service organization in Northern Tanzania.
abstract: OBJECTIVE
  We evaluated the cost-effectiveness of fee-based and free testing strategies at an HIV voluntary counseling and testing (VCT) program integrated into a community-based AIDS service organization in Moshi, Tanzania.
  
  
  METHODS
  We waived the usual fee schedule during a 2-week free, advertised VCT campaign; analyzed the number of clients testing per day during prefree, free, and postfree testing periods; and estimated the cost-effectiveness of limited and sustained free testing strategies.
  
  
  RESULTS
  The number of clients testing per day increased from 4.1 during the prefree testing interval to 15.0 during the free testing campaign (P<.0001) and remained significantly increased at 7.1 (P<.0001) after resumption of the standard fees. HIV seroprevalence (16.7%) and risk behaviors were unchanged over these intervals. Modeled over 1 year, the costs per infection averted with the standard fee schedule, with a 2-week free VCT campaign, and with sustained free VCT year-round were $170, $105, and $92, respectively, and the costs per disability-adjusted life year gained were $8.72, $5.40, and $4.72, respectively.
  
  
  CONCLUSIONS
  The provision of free VCT enhances both the number of clients testing per day and its cost-effectiveness in resource-limited settings.
authors.affiliation: Division of Infectious Diseases and International Health, Duke University Medical Center, Box 3867, Durham, NC 27701, USA.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
authors.forename: Helen Y
authors.initials: HY
authors.lastname: Chu
authors.forename: Jan
authors.initials: J
authors.lastname: Ostermann
authors.forename: Dafrosa K
authors.initials: DK
authors.lastname: Itemba
authors.forename: Anna
authors.initials: A
authors.lastname: Mgonja
authors.forename: Sabina
authors.initials: S
authors.lastname: Mtweve
authors.forename: John A
authors.initials: JA
authors.lastname: Bartlett
authors.forename: John F
authors.initials: JF
authors.lastname: Shao
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
mesh_terms: D015492:AIDS Serodiagnosis / Q000191:economics*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use; D003153:Community Health Services / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D015528:HIV Seroprevalence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012309:Risk-Taking; D012725:Sexual Behavior; D013636:Tanzania
chemical_list: D044966:Anti-Retroviral Agents