Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study
Abstract Background HIV assisted partner services (aPS), or provider notification and testing for sexual and injecting partners of people diagnosed with HIV, is shown to be safe, effective, and cost-effective and was scaled up within the national HIV testing services (HTS) program in Kenya in 2016....
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-07479-4 |
| _version_ | 1819006751945523200 |
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| author | Beatrice Wamuti Monisha Sharma Edward Kariithi Harison Lagat George Otieno Rose Bosire Sarah Masyuko Mary Mugambi Bryan J. Weiner David A. Katz Carey Farquhar Carol Levin |
| author_facet | Beatrice Wamuti Monisha Sharma Edward Kariithi Harison Lagat George Otieno Rose Bosire Sarah Masyuko Mary Mugambi Bryan J. Weiner David A. Katz Carey Farquhar Carol Levin |
| author_sort | Beatrice Wamuti |
| collection | DOAJ |
| description | Abstract Background HIV assisted partner services (aPS), or provider notification and testing for sexual and injecting partners of people diagnosed with HIV, is shown to be safe, effective, and cost-effective and was scaled up within the national HIV testing services (HTS) program in Kenya in 2016. We estimated the costs of integrating aPS into routine HTS within an ongoing aPS scale-up project in western Kenya. Methods We conducted microcosting using the payer perspective in 14 facilities offering aPS. Although aPS was offered to both males and females testing HIV-positive (index clients), we only collected data on female index clients and their male sex partners (MSP). We used activity-based costing to identify key aPS activities, inputs, resources, and estimated financial and economic costs of goods and services. We analyzed costs by start-up (August 2018), and recurrent costs one-year after aPS implementation (Kisumu: August 2019; Homa Bay: January 2020) and conducted time-and-motion observations of aPS activities. We estimated the incremental costs of aPS, average cost per MSP traced, tested, testing HIV-positive, and on antiretroviral therapy, cost shares, and costs disaggregated by facility. Results Overall, the number of MSPs traced, tested, testing HIV-positive, and on antiretroviral therapy was 1027, 869, 370, and 272 respectively. Average unit costs per MSP traced, tested, testing HIV-positive, and on antiretroviral therapy were $34.54, $42.50, $108.71 and $152.28, respectively, which varied by county and facility client volume. The weighted average incremental cost of integrating aPS was $7,485.97 per facility per year, with recurrent costs accounting for approximately 90% of costs. The largest cost drivers were personnel (49%) and transport (13%). Providers spent approximately 25% of the HTS visit obtaining MSP contact information (HIV-negative clients: 13 out of 54 min; HIV-positive clients: 20 out of 96 min), while the median time spent per MSP traced on phone and in-person was 6 min and 2.5 hours, respectively. Conclusion Average facility costs will increase when integrating aPS to HTS with incremental costs largely driven by personnel and transport. Strategies to efficiently utilize healthcare personnel will be critical for effective, affordable, and sustainable aPS. |
| first_indexed | 2024-12-21T00:13:40Z |
| format | Article |
| id | doaj.art-6ff3d5560e3a4a278a9a0b67212bec9b |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-21T00:13:40Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-6ff3d5560e3a4a278a9a0b67212bec9b2022-12-21T19:22:18ZengBMCBMC Health Services Research1472-69632022-01-0122111110.1186/s12913-022-07479-4Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting studyBeatrice Wamuti0Monisha Sharma1Edward Kariithi2Harison Lagat3George Otieno4Rose Bosire5Sarah Masyuko6Mary Mugambi7Bryan J. Weiner8David A. Katz9Carey Farquhar10Carol Levin11Department of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonPATH- KenyaPATH- KenyaPATH- KenyaKenya Medical Research InstituteDepartment of Global Health, University of WashingtonMinistry of HealthDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonAbstract Background HIV assisted partner services (aPS), or provider notification and testing for sexual and injecting partners of people diagnosed with HIV, is shown to be safe, effective, and cost-effective and was scaled up within the national HIV testing services (HTS) program in Kenya in 2016. We estimated the costs of integrating aPS into routine HTS within an ongoing aPS scale-up project in western Kenya. Methods We conducted microcosting using the payer perspective in 14 facilities offering aPS. Although aPS was offered to both males and females testing HIV-positive (index clients), we only collected data on female index clients and their male sex partners (MSP). We used activity-based costing to identify key aPS activities, inputs, resources, and estimated financial and economic costs of goods and services. We analyzed costs by start-up (August 2018), and recurrent costs one-year after aPS implementation (Kisumu: August 2019; Homa Bay: January 2020) and conducted time-and-motion observations of aPS activities. We estimated the incremental costs of aPS, average cost per MSP traced, tested, testing HIV-positive, and on antiretroviral therapy, cost shares, and costs disaggregated by facility. Results Overall, the number of MSPs traced, tested, testing HIV-positive, and on antiretroviral therapy was 1027, 869, 370, and 272 respectively. Average unit costs per MSP traced, tested, testing HIV-positive, and on antiretroviral therapy were $34.54, $42.50, $108.71 and $152.28, respectively, which varied by county and facility client volume. The weighted average incremental cost of integrating aPS was $7,485.97 per facility per year, with recurrent costs accounting for approximately 90% of costs. The largest cost drivers were personnel (49%) and transport (13%). Providers spent approximately 25% of the HTS visit obtaining MSP contact information (HIV-negative clients: 13 out of 54 min; HIV-positive clients: 20 out of 96 min), while the median time spent per MSP traced on phone and in-person was 6 min and 2.5 hours, respectively. Conclusion Average facility costs will increase when integrating aPS to HTS with incremental costs largely driven by personnel and transport. Strategies to efficiently utilize healthcare personnel will be critical for effective, affordable, and sustainable aPS.https://doi.org/10.1186/s12913-022-07479-4CostIntegrationHIVAssisted partner servicesKenyaMicrocosting |
| spellingShingle | Beatrice Wamuti Monisha Sharma Edward Kariithi Harison Lagat George Otieno Rose Bosire Sarah Masyuko Mary Mugambi Bryan J. Weiner David A. Katz Carey Farquhar Carol Levin Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study BMC Health Services Research Cost Integration HIV Assisted partner services Kenya Microcosting |
| title | Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study |
| title_full | Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study |
| title_fullStr | Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study |
| title_full_unstemmed | Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study |
| title_short | Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study |
| title_sort | cost of integrating assisted partner services in hiv testing services in kisumu and homa bay counties kenya a microcosting study |
| topic | Cost Integration HIV Assisted partner services Kenya Microcosting |
| url | https://doi.org/10.1186/s12913-022-07479-4 |
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