The Aurum Institute, Aurum House, The Ridge, Johannesburg, South Africa.
Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
PLoS One. 2022 Aug 25;17(8):e0272595. doi: 10.1371/journal.pone.0272595. eCollection 2022.
Universal test and treat (UTT) is a population-based strategy that aims to ensure widespread HIV testing and rapid antiretroviral therapy (ART) for all who have tested positive regardless of CD4 count to decrease HIV incidence and improve health outcomes. Little is known about the specific resources required to implement UTT in correctional facilities for incarcerated people. The primary aim of this study was to describe the resources used to implement UTT and to provide detailed costing to inform UTT scale-up in similar settings.
The costing study was a cross-sectional descriptive study conducted in three correctional complexes, Johannesburg Correctional Facility in Johannesburg (>4000 inmates) South Africa, and Brandvlei (3000 inmates), South Africa and Lusaka Central (1400 inmates), Zambia. Costing was determined through a survey conducted between September and December 2017 that identified materials and labour used for three separate components of UTT: HIV testing services (HTS), ART initiation, and ART maintenance. Our study participants were staff working in the correctional facilities involved in any activity related to UTT implementation. Unit costs were reported as cost per client served while total costs were reported for all clients seen over a 12-month period.
The cost of HIV testing services (HTS) per client was $ 92.12 at Brandvlei, $ 73.82 at Johannesburg, and $ 65.15 at Lusaka. The largest cost driver for HIV testing at Brandvlei were staff costs at 55.6% of the total cost, while at Johannesburg (56.5%) and Lusaka (86.6%) supplies were the largest contributor. The cost per client initiated on ART was $917 for Brandvlei, $421.8 for Johannesburg, and $252.1 for Lusaka. The activity cost drivers were adherence counselling at Brandvlei (59%), and at Johannesburg and Lusaka it was the actual ART initiation at 75.6% and 75.8%, respectively. The annual unit cost for ART maintenance was $2,640.6 for Brandvlei, $710 for Johannesburg, and $385.5 for Lusaka. The activity cost drivers for all three facilities were side effect monitoring, and initiation of isoniazid preventive treatment (IPT), cotrimoxazole, and fluconazole, with this comprising 44.7% of the total cost at Brandvlei, 88.9% at Johannesburg, and 50.5% at Lusaka.
Given the needs of this population, the opportunity to reach inmates at high risk for HIV, and overall national and global 95-95-95 goals, the UTT policies for incarcerated individuals are of vital importance. Our findings provide comparator costing data and highlight key drivers of UTT cost by facility.
普遍检测和治疗（UTT）是一种基于人群的策略，旨在确保对所有检测呈阳性的人进行广泛的 HIV 检测和快速抗逆转录病毒治疗（ART），无论其 CD4 计数如何，以降低 HIV 发病率和改善健康结果。对于在监禁场所实施 UTT 需要哪些具体资源，人们知之甚少。本研究的主要目的是描述实施 UTT 所使用的资源，并提供详细的成本信息，以便在类似环境中扩大 UTT 的规模。
本成本研究是一项横断面描述性研究，在南非约翰内斯堡的约翰内斯堡惩教设施（>4000 名囚犯）、南非布兰德维利（3000 名囚犯）和赞比亚卢萨卡中心（1400 名囚犯）进行。成本确定是通过 2017 年 9 月至 12 月期间进行的一项调查，该调查确定了 UTT 三个独立部分（HIV 检测服务（HTS）、ART 启动和 ART 维持）所用的材料和劳动力。我们的研究参与者是在与 UTT 实施相关的惩教设施中从事任何相关活动的工作人员。单位成本按每服务一位客户报告，而总成本则按在 12 个月期间看到的所有客户报告。
布兰德维利的 HIV 检测服务（HTS）每位客户的成本为 92.12 美元，约翰内斯堡为 73.82 美元，卢萨卡为 65.15 美元。布兰德维利 HIV 检测最大的成本驱动因素是员工成本，占总成本的 55.6%，而约翰内斯堡（56.5%）和卢萨卡（86.6%）的供应品是最大的贡献者。每位客户开始接受 ART 治疗的成本为布兰德维利 917 美元、约翰内斯堡 421.8 美元、卢萨卡 252.1 美元。活动成本驱动因素是布兰德维利的依从性咨询（59%），而约翰内斯堡和卢萨卡的活动成本驱动因素是实际的 ART 启动，分别占 75.6%和 75.8%。ART 维持的年度单位成本为布兰德维利 2640.6 美元、约翰内斯堡 710 美元、卢萨卡 385.5 美元。所有三个设施的活动成本驱动因素均为副作用监测以及异烟肼预防性治疗（IPT）、复方磺胺甲噁唑和氟康唑的启动，这在布兰德维利占总成本的 44.7%，在约翰内斯堡占 88.9%，在卢萨卡占 50.5%。
鉴于该人群的需求、为艾滋病毒高风险囚犯提供服务的机会以及国家和全球 95-95-95 目标的总体情况，囚犯普遍检测和治疗政策至关重要。我们的研究结果提供了可比的成本数据，并突出了按设施划分的 UTT 成本的主要驱动因素。
