title: Implementation and Operational Research: Cost and Efficiency of a Hybrid Mobile Multidisease Testing Approach With High HIV Testing Coverage in East Africa.
abstract: In 2013-2014, we achieved 89% adult HIV testing coverage using a hybrid testing approach in 32 communities in Uganda and Kenya (SEARCH: NCT01864603). To inform scalability, we sought to determine: (1) overall cost and efficiency of this approach; and (2) costs associated with point-of-care (POC) CD4 testing, multidisease services, and community mobilization.
  
  
  
  We applied microcosting methods to estimate costs of population-wide HIV testing in 12 SEARCH trial communities. Main intervention components of the hybrid approach are census, multidisease community health campaigns (CHC), and home-based testing for CHC nonattendees. POC CD4 tests were provided for all HIV-infected participants. Data were extracted from expenditure records, activity registers, staff interviews, and time and motion logs.
  
  
  
  The mean cost per adult tested for HIV was $20.5 (range: $17.1-$32.1) (2014 US$), including a POC CD4 test at $16 per HIV+ person identified. Cost per adult tested for HIV was $13.8 at CHC vs. $31.7 by home-based testing. The cost per HIV+ adult identified was $231 ($87-$1245), with variability due mainly to HIV prevalence among persons tested (ie, HIV positivity rate). The marginal costs of multidisease testing at CHCs were $1.16/person for hypertension and diabetes, and $0.90 for malaria. Community mobilization constituted 15.3% of total costs.
  
  
  
  The hybrid testing approach achieved very high HIV testing coverage, with POC CD4, at costs similar to previously reported mobile, home-based, or venue-based HIV testing approaches in sub-Saharan Africa. By leveraging HIV infrastructure, multidisease services were offered at low marginal costs.
authors.affiliation: *Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA; †Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA; ‡School of Economics, University of Nairobi, Nairobi, Kenya; §Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC; ‖Center for AIDS Prevention Studies, University of California, San Francisco, CA; ¶Department of Biostatistics, University of California, Berkeley, CA; #Infectious Disease Research Collaboration, Kampala, Uganda; **Kenya Medical Research Institute, Nairobi, Kenya; ††Division of HIV Prevention, Makerere University Joint AIDS Program, Kampala, Uganda; ‡‡Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA; and §§Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Wei
authors.initials: W
authors.lastname: Chang
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chamie
authors.forename: Daniel
authors.initials: D
authors.lastname: Mwai
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Clark
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: Maya
authors.initials: M
authors.lastname: Petersen
authors.forename: Jane
authors.initials: J
authors.lastname: Kabami
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ssemmondo
authors.forename: Kevin
authors.initials: K
authors.lastname: Kadede
authors.forename: Dalsone
authors.initials: D
authors.lastname: Kwarisiima
authors.forename: Norton
authors.initials: N
authors.lastname: Sang
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.forename: Moses
authors.initials: M
authors.lastname: Kamya
authors.forename: Diane V
authors.initials: DV
authors.lastname: Havlir
authors.forename: James G
authors.initials: JG
authors.lastname: Kahn
mesh_terms: D018791:CD4 Lymphocyte Count; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000175:diagnosis*; D006293:Health Promotion / Q000191:economics / Q000379:methods; D006801:Humans; D007630:Kenya; D008403:Mass Screening / Q000191:economics* / Q000379:methods* / Q000458:organization & administration; D008952:Mobile Health Units / Q000191:economics / Q000458:organization & administration; D009874:Operations Research; D019095:Point-of-Care Systems; D016032:Randomized Controlled Trials as Topic; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration; D012424:Rural Population; D014454:Uganda