A Cost-Effectiveness Analysis of a Home-Based HIV Counselling and Testing Intervention versus the Standard (Facility Based) HIV Testing Strategy in Rural South Africa.
BACKGROUND
There is growing evidence concerning the acceptability and feasibility of home-based HIV testing. However, less is known about the cost-effectiveness of the approach yet it is a critical component to guide decisions about scaling up access to HIV testing. This study examined the cost-effectiveness of a home-based HIV testing intervention in rural South Africa.


METHODS
Two alternatives: clinic and home-based HIV counselling and testing were compared. Costs were analysed from a provider's perspective for the period of January to December 2010. The outcome, HIV counselling and testing (HCT) uptake was obtained from the Good Start home-based HIV counselling and testing (HBHCT) cluster randomised control trial undertaken in KwaZulu-Natal province. Cost-effectiveness was estimated for a target population of 22,099 versus 23,864 people for intervention and control communities respectively. Average costs were calculated as the cost per client tested, while cost-effectiveness was calculated as the cost per additional client tested through HBHCT.


RESULTS
Based on effectiveness of 37% in the intervention (HBHCT) arm compared to 16% in control arm, home based testing costs US$29 compared to US$38 per person for clinic HCT. The incremental cost effectiveness per client tested using HBHCT was $19.


CONCLUSIONS
HBHCT was less costly and more effective. Home-based HCT could present a cost-effective alternative for rural 'hard to reach' populations depending on affordability by the health system, and should be considered as part of community outreach programs.
Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; School of Public Health, University of the Western Cape, Cape Town, South Africa.
Hanani
H
Tabana
Division of Community Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
Lungiswa
L
Nkonki
Population Health, Health Systems and Innovation, Human Sciences Research Council, Pretoria, South Africa.
Charles
C
Hongoro
Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa; School of Public Health, University of the Western Cape, Cape Town, South Africa.
Tanya
T
Doherty
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Anna Mia
AM
Ekström
Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa; Department of Global Health, Boston University School of Public Health, Boston, United States of America; Population Reference Bureau, 1875 Connecticut Avenue, NW Suite 520, Washington, DC, United States of America.
Reshma
R
Naik
Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa.
Wanga
W
Zembe-Mkabile
School of Public Health, University of the Western Cape, Cape Town, South Africa.
Debra
D
Jackson
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Anna
A
Thorson
D003365:Costs and Cost Analysis; D003376:Counseling / Q000191:economics / Q000379:methods; D061345:Early Medical Intervention / Q000191:economics / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D008297:Male; D012424:Rural Population; D013019:South Africa