Cost And Effectiveness Of Hiv Testing And Counseling Service Delivery Strategies In Namibia

ABSTRACT

HIV Testing and Counseling (HTC) remains an important entry to HIV Prevention,

treatment, care and support services. According to the Namibian 2013 Demographic

Health Survey (DHS), HTC services among 15-49 year old showed a marked increase,

with 79% females and 61% males ever tested against the 2006/7 DHS results with 51%

and 32% among females and males respectively. However although testing rates have

increased the 2015 WHO HIV Testing Services (HTS) Consolidated Guideline

indicates that there are still significant gaps remaining in reaching undiagnosed HIV

infected people and effectively linking them to treatment, care and support services

with efficient use of limited available resources. The purpose of this study was to

determine the cost and effectiveness of delivering different HTC service delivery

strategies in Namibia to inform program implementation and efficient resource

utilization. The HIV Testing and Counseling Strategies under investigation is facility

based strategies including Provider Initiated Testing and Counseling, Integrated

Voluntary Counseling and Testing and standalone services (Client initiated

testing).Community based strategies such as mobile/outreaches to workplaces and

national testing day events was also investigated. A retrospective review of HTC

service and expenditure records was done for the Namibian Government (GRN)

Financial Years 2010/11-2012/13. Data was analyzed using Epi info version 7.

Results indicated that 72% of all HIV tests reported to the Ministry of Health and

Social Services (MoHSS) were conducted at Public Health Facilities (PHF). National

Testing Day (NTD) and Standalone facilities conducted 15% and 12% of the tests

respectively with workplaces recording the lowest proportion of 0.9%. The highest

HIV positivity rate of 21% was identified at workplaces followed by PHF with 9%

and 5% for NTD.

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Workplace had the highest proportion of males tested with 65% and standalone

facilities reached the highest proportion of couples tested at 18%. The estimated cost

per HIV positive client identified indicated that NTD and PHF recorded the lowest

cost with 247 US$ and 297 US$ respectively. Standalone and Workplace

had the highest cost per positives identified at 718 US$ for Standalone and 3,791 US$

for Workplace.

PHF presents the best strategy to reach more clientele at a low cost. PHF have

opportunities to maximize this potential with the ongoing expansion of Provider

Initiated Testing and Counseling (PITC) in Namibia. If alternative modalities to

reduce service costs are applied, workplace HTC services have significant potential

to reach men who are hard to reach through mainstream services and are more likely

to be HIV positive. Standalone HTC strategies have potential to improve efficiency

while strengthening their ability to reach more couples. NTD identified the lowest

cost per positive client identified but because of a high number of repeat HTC testers,

this approach needs better targeting to find new HIV positive clients. In conclusion

this study indicates that PHF reach more clients with HTC and was effective in

identifying HIV infected people at a lower cost in Namibia. However, there is a need

to complement this strategy with the other service delivery strategies whose

efficiency needs to be strengthened in order to remain relevant in contributing to the

National HTC Strategy.