Cost and Cost-Effectiveness of Facility, Standalone and Mobile Based VCT in Addis Ababa, Ethiopia

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Addis Ababa Universty


Background: Early diagnosis of HIV virus is a determinant for effective treatment of the disease with less costs than a late treatment. Mobile based VCT as part of community HIV testing and counselling service is suited to highly populated settings. Recently the world has agreement on UNAIDS 90-90-90 goals to achieve 90% of people living with HIV to know their HIV status by 2020 and end the AIDS epidemic by 2030. Despite the agreement, HIV testing and counselling continues to be undertaken predominantly in health facilities, even if there is strong evidence on clients’ preference to test in the community. Hence, empirically studied cost-effective HIV testing and counselling model is desirable to achieve the goal. Objective: The objective of this study is to describe the cost and compare the cost-effectiveness of Facility, Standalone and Mobile based VCT in Addis Ababa, Ethiopia. Methods: Ingredients costing method and reciprocal cost allocation approach based on a provider perspective in view of economic costs was performed from July 2016 to June 2017 (2009 EFY). Effectiveness is measured by HIV-seropositive individual identified. A cross sectional study design using Decision tree modelling on TreeAge 2018 software was performed. One way and Probabilistic sensitivity analysis were conducted on HIV prevalence, costs, and probabilities. Result: The mean cost per client tested for HIV in Facility, Standalone and Mobile based VCT are USD 4.9, 6.6 and 3.7 respectively. The mean cost per HIV seropositive client identified for the corresponding models are USD 153.6, 154.1 and 138.8 respectively. From the three models, Standalone based VCT is extendedly dominated. The incremental cost of Mobile based VCT is USD 192.1 for every additional HIV positive clients identified when compared to Facility based VCT. Conclusion: More resources should be allocated to HIV prevention through mobile testing to eliminate HIV transmission and start ART early in the disease progression as Mobile based VCT is effective in diagnosing higher number of HIV positive individuals than Facility based VCT with higher costs. As the HIV prevalence in Ethiopia is becoming more concentrated in urban areas, more effort should be made for the provision of HIV counseling and testing service by implementing testing through Mobile based VCT to reach the 90-90-90 goal set by UNAIDS.



Ingredients costing, decision tree modelling, reciprocal cost allocation, cost effectiveness analysis, and VCT models