title: Costs of integrating cervical cancer screening at an HIV clinic in Kenya.
abstract: OBJECTIVE
  To estimate the societal-level costs of integrating cervical cancer screening into HIV clinics in Nairobi, Kenya.
  
  
  METHODS
  A cross-sectional micro-costing study was performed at Coptic Hope Center for Infectious Diseases and Kenyatta National Hospital, Kenya, between July 1 and October 31, 2014. To estimate direct medical, non-medical, and indirect costs associated with screening, a time-and-motion study was performed, and semi-structured interviews were conducted with women aged at least 18 years attending the clinic for screening during the study period and with clinic staff who had experience relevant to cervical cancer screening.
  
  
  RESULTS
  There were 148 patients and 23 clinic staff who participated in interviews. Visual inspection with acetic acid was associated with the lowest estimated marginal per-screening costs ($3.30), followed by careHPV ($18.28), Papanicolaou ($24.59), and Hybrid Capture 2 screening ($31.15). Laboratory expenses were the main cost drivers for Papanicolaou and Hybrid Capture 2 testing ($11.61 and $16.41, respectively). Overhead and patient transportation affected the costs of all methods. Indirect costs were cheaper for single-visit screening methods ($0.43 per screening) than two-visit screening methods ($2.88 per screening).
  
  
  CONCLUSIONS
  Integrating cervical cancer screening into HIV clinics would be cost-saving from a societal perspective compared with non-integrated screening. These findings could be used in cost-effectiveness analyses to assess incremental costs per clinical outcome in an integrated setting.
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Elisabeth L
authors.initials: EL
authors.lastname: Vodicka
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Babigumira
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Marita R
authors.initials: MR
authors.lastname: Mann
authors.affiliation: University of Nairobi, Nairobi, Kenya.|Kenyatta National Hospital, Nairobi, Kenya.
authors.forename: Rose J
authors.initials: RJ
authors.lastname: Kosgei
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Fan
authors.initials: F
authors.lastname: Lee
authors.affiliation: University of Nairobi, Nairobi, Kenya.|Kenyatta National Hospital, Nairobi, Kenya.|Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Nelly R
authors.initials: NR
authors.lastname: Mugo
authors.affiliation: United States International University, University of Lukasa, Nairobi, Kenya.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Okech
authors.affiliation: Coptic Hope Center for Infectious Diseases, Nairobi, Kenya.
authors.forename: Samah R
authors.initials: SR
authors.lastname: Sakr
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D007630:Kenya; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D065006:Papanicolaou Test; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D055815:Young Adult
keywords: Cervical cancer screening; Economic costs; HIV; Health services delivery integration; Kenya; Low- and middle-income countries