Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Institute for Global Health Innovation, Imperial College London, London, UK.
BMC Health Serv Res. 2021 Oct 12;21(1):1082. doi: 10.1186/s12913-021-07070-3.
By testing children and adolescents of HIV positive caretakers, index-linked HIV testing, a targeted HIV testing strategy, has the ability to identify high risk children and adolescents earlier and more efficiently, compared to blanket testing. We evaluated the incremental cost of integrating index-linked HIV testing via three modalities into HIV services in Zimbabwe.
A mixture of bottom-up and top-down costing was employed to estimate the provider cost per test and per HIV diagnosis for 2-18 year olds, through standard of care testing, and the incremental cost of index-linked HIV testing via three modalities: facility-based testing, home-based testing by a healthcare worker, and testing at home by the caregiver using an oral mucosal transudate test. In addition to interviews, direct observation and study process data, facility registries were abstracted to extract outcome data and resource use. Costs were converted to 2019 constant US$.
The average cost per standard of care test in urban facilities was US$5.91 and US$7.15 at the rural facility. Incremental cost of an index-linked HIV test was driven by the uptake and number of participants tested. The lowest cost approach in the urban setting was home-based testing (US$6.69) and facility-based testing at the rural clinic (US$5.36). Testing by caregivers was almost always the most expensive option (rural US$62.49, urban US$17.49).
This is the first costing analysis of index-linked HIV testing strategies. Unit costs varied across sites and with uptake. When scaling up, alternative testing solutions that increase efficiency such as index-linked HIV testing of the entire household, as opposed to solely targeting children/adolescents, need to be explored.
通过对 HIV 阳性照顾者的儿童和青少年进行检测，索引关联 HIV 检测作为一种有针对性的 HIV 检测策略，与全面检测相比，能够更早、更有效地发现高危儿童和青少年。我们评估了通过三种方式将索引关联 HIV 检测整合到津巴布韦 HIV 服务中的增量成本。
采用自下而上和自上而下的混合成本估算方法，通过标准护理检测，估计每个测试和每个 HIV 诊断的提供者成本，适用于 2-18 岁的儿童和青少年，以及通过三种方式进行索引关联 HIV 检测的增量成本：医疗机构检测、医疗保健工作者的家庭检测和照顾者使用口腔黏膜渗出液测试进行家庭检测。除了访谈、直接观察和研究过程数据外，还从设施登记处提取了结果数据和资源使用情况。成本已转换为 2019 年不变的美元。
城市设施标准护理检测的平均成本为 5.91 美元，农村设施为 7.15 美元。索引关联 HIV 检测的增量成本取决于参与率和接受检测的人数。在城市环境中，成本最低的方法是家庭检测（6.69 美元）和农村诊所的医疗机构检测（5.36 美元）。由照顾者进行的检测几乎总是最昂贵的选择（农村地区 62.49 美元，城市地区 17.49 美元）。
这是首次对索引关联 HIV 检测策略进行成本分析。单位成本因地点和参与率而异。在扩大规模时，需要探索替代检测解决方案，以提高效率，例如对整个家庭进行索引关联 HIV 检测，而不是仅针对儿童/青少年进行检测。
