Costs and outcomes of VCT delivery models in the context of scaling up services in Indonesia.
OBJECTIVE
To evaluate costs and outcomes of voluntary counselling and testing (VCT) service delivery models in urban Indonesia.


METHODS
We collected primary data on utilization, costs and outcomes of VCT services in a hospital clinic (568 clients), HIV community clinic (28 clients), sexually transmitted infection (STI) community clinic (784 clients) and prison clinic (574 clients) in Bandung, Indonesia, in the period January 2008-April 2009.


RESULTS
The hospital clinic diagnosed the highest proportion and absolute number of HIV infections, but with the lowest average CD4 cell count and with the highest associated travelling and waiting time. The prison clinic detected fewer cases, but at an earlier stage, and all enrolled in HIV care. The community clinics detected the smallest number of cases, and only 0-8% enrolled in HIV care. The unit cost per VCT was highest in the hospital clinic (US$74), followed by the STI community clinic (US$65), the HIV community clinic (US$39) and the prison (US$23).


CONCLUSIONS
We propose a reorientation of the delivery models for VCT and related HIV/AIDS treatment in this setting. We call for the scaling up of community clinics for VCT to improve access, promote earlier detection and to perform (early) treatment activities. This would reduce the burden of the hospital clinic to orient itself towards the treatment of AIDS patients. This is one of very few studies addressing this issue in Asia and the first of its kind in Indonesia, which has a rapidly growing HIV epidemic. The conceptual framework and overall conclusions may be relevant to other low-income settings.
Integrated Management for Prevention and Control and Treatment of HIV/AIDS, Bandung, Indonesia. adiatma.siregar@fe.unpad.ac.id
Adiatma Y M
AY
Siregar
Dindin
D
Komarudin
Rudi
R
Wisaksana
Reinout
R
van Crevel
Rob
R
Baltussen
D015492:AIDS Serodiagnosis / Q000191:economics* / Q000706:statistics & numerical data; D000328:Adult; D017281:Cost of Illness; D003376:Counseling / Q000191:economics* / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007214:Indonesia; D008297:Male; D017146:Models, Organizational; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000191:economics / Q000706:statistics & numerical data