title: The increased effectiveness of HIV preventive intervention among men who have sex with men and of follow-up care for people living with HIV after 'task-shifting' to community-based organizations: a 'cash on service delivery' model in China.
abstract: BACKGROUND
  A large number of men who have sex with men (MSM) and people living with HIV/AIDS (PLHA) are underserved despite increased service availability from government facilities while many community based organizations (CBOs) are not involved. We aimed to assess the feasibility and effectiveness of the task shifting from government facilities to CBOs in China.
  
  
  METHODS
  HIV preventive intervention for MSM and follow-up care for PLHA were shifted from government facilities to CBOs. Based on 'cash on service delivery' model, 10 USD per MSM tested for HIV with results notified, 82 USD per newly HIV cases diagnosed, and 50 USD per PLHA received a defined package of follow-up care services, were paid to the CBOs. Cash payments were made biannually based on the verified results in the national web-based HIV/AIDS information system.
  
  
  RESULTS
  After task shifting, CBOs gradually assumed preventive intervention for MSM and follow-up care for PLHA from 2008 to 2012. HIV testing coverage among MSM increased from 4.1% in 2008 to 22.7% in 2012. The baseline median CD4 counts of newly diagnosed HIV positive MSM increased from 309 to 397 cells/µL. HIV tests among MSM by CBOs accounted for less than 1% of the total HIV tests in Nanjing but the share of HIV cases detected by CBOs was 12.4% in 2008 and 43.6% in 2012. Unit cost per HIV case detected by CBOs was 47 times lower than that by government facilities. The coverage of CD4 tests and antiretroviral therapy increased from 71.1% and 78.6% in 2008 to 86.0% and 90.1% in 2012, respectively.
  
  
  CONCLUSIONS
  It is feasible to shift essential HIV services from government facilities to CBOs, and to verify independently service results to adopt 'cash on service delivery' model. Services provided by CBOs are cost-effective, as compared with that by government facilities.
authors: Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
authors: Hongjing
authors: H
authors: Yan
authors: Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors: Min
authors: M
authors: Zhang
authors: Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China; The Global Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
authors: Jinkou
authors: J
authors: Zhao
authors: Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China; Jiangsu Provincial Preventive Medicine Association, Nanjing, China.
authors: Xiping
authors: X
authors: Huan
authors: Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China; Jiangsu Provincial Preventive Medicine Association, Nanjing, China.
authors: Jianping
authors: J
authors: Ding
authors: Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors: Susu
authors: S
authors: Wu
authors: Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors: Chenchen
authors: C
authors: Wang
authors: Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors: Yuanyuan
authors: Y
authors: Xu
authors: Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors: Li
authors: L
authors: Liu
authors: Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
authors: Fei
authors: F
authors: Xu
authors: Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
authors: Haitao
authors: H
authors: Yang
mesh_terms: D002681:China / Q000453:epidemiology; D003153:Community Health Services / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening; D010865:Pilot Projects