Cost effectiveness of facility and home based HIV voluntary counseling and testing strategies in rural Uganda.
BACKGROUND
In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) has been at health facilities. Home based VCT on the other hand, was initiated in the country to improve service coverage.


OBJECTIVE
To evaluate the cost effectiveness of facility- and home-based HIV VCT strategies in rural southwestern Uganda.


METHODS
Data on costs and effectiveness of facility- and home-based HIV VCT intervention strategies was collected in two sub-Counties in rural southwestern Uganda. Costing was performed using the ingredients approach. Effectiveness was measured as the number of HIV sero-positive clients identified. Incremental Cost-Effectiveness Ratios (ICERs) were calculated from the provider perspective.


RESULTS
The cost per client tested were US$6.4 for facility based VCT and US$5.0 for home based VCT. The corresponding costs per positive case identified were US$86.5 and US$54.7 respectively. The incremental cost to providers per additional positive case identified by facility based VCT was US$3.5.


CONCLUSIONS
Home based VCT was the least costly strategy per client tested and was also cost effective in identifying HIV sero-positive clients in rural areas. This strategy should therefore be promoted to improve service coverage and thereby facilitate early and extensive detection of clients eligible for treatment.
Department of Community Health, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda.
E M
EM
Mulogo
V
V
Batwala
F
F
Nuwaha
A S
AS
Aden
O S
OS
Baine
D000328:Adult; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics*; D003955:Diagnostic Tests, Routine / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006268:Health Facilities; D006699:Home Care Services; D006801:Humans; D008297:Male; D012424:Rural Population; D011795:Surveys and Questionnaires; D014454:Uganda; D055815:Young Adult
Uganda; cost effectiveness; facility and home based VCT; positive cases identified