Cost of Home-Based Couples Human Immunodeficiency Virus Counseling and Testing and Human Immunodeficiency Virus Self-Testing During Pregnancy and Postpartum in Southwestern Kenya.

OBJECTIVE: Home-based couples HIV testing and counseling and HIV self-testing (HIVST) for pregnant women can promote HIV status disclosure and male partner testing; however, cost data are lacking. We examined a home-based couples intervention (HBCI) and HIVST intervention costs per couple (unit cost) during pregnancy and postpartum in Kenya. METHODS: This randomized controlled trial is comparing HBCI and HIVST for couples among pregnant women attending antenatal care clinics in two counties in southwestern Kenya. We used micro-costing to estimate the unit cost per couple receiving the intervention as the total of direct and indirect costs for each study arm in 2019 US$. We used a one-month window to conduct a time and motion study to determine personnel effort and resources. We then compared the unit cost by arm, identified key cost drivers, and conducted sensitivity analyses for cost uncertainties. RESULTS: At base-case, the unit cost was $129.01 and $41.99, respectively, for HBCI and HIVST. Personnel comprised half of the unit cost for both arms. Staff spent more time on activities related to participant engagement in HBCI (accounting for 6.4% of the unit cost) than in HIVST (2.3%). Staff training was another key cost driver in HBCI (20.1% of the unit cost compared to 12.5% in HIVST). Sensitivity analyses revealed that the unit cost ranges were $104.64-$154.54 for HBCI and $30.49-$56.59 for HIVST. CONCLUSIONS: Our findings may guide spending decisions for future HIV prevention and treatment programs for pregnant couples in resource-limited settings such as Kenya.

Behaviors and Risks for Cardiovascular Disease Among Muslim Women in the United States.

Purpose: This study examines statistical associates of cardiovascular disease risk factors, as defined by the American Heart Association's Life's Simple Seven, among Muslim women who reside in the United States. Methods: Data collected nationally through the 2015 Muslim Women's Health project were analyzed (N=373). Logistic regression models estimated associations between sample characteristics and diet, exercise, alcohol consumption, blood pressure, cholesterol, and weight. Results: Over half of respondents reported exercising regularly (64%) and maintaining a healthy diet (85%); 20% consumed alcohol. About 5% reported having high cholesterol, 4% had high blood pressure, and 42% reported being overweight. Perceived and experienced stigma were associated with alcohol use (odds ratio [OR]=1.085, p<0.001) and being overweight (OR=0.938, p<0.001). Married respondents had 42% lower odds of exercising and 83% lower odds of drinking alcohol. Compared to foreign-born respondents, U.S.-born respondents had 2.9 higher odds of drinking alcohol and 2.7 higher odds of having high cholesterol (OR=2.931, p<0.001; OR=2.732, p<0.01, respectively). Significant effects were also found when examining the statistical impact of of age, Islamic sect, and education on cardiovascular disease risk factors. Conclusion: With increasing focus on precision medicine, personalized healthcare, and patient-centered medical homes (all interventions designed to promote disease prevention and assist in managing chronic health conditions) better understanding the health of understudied populations is imperative to the success of these interventions. Our findings suggest countervailing forces may affect the health of American Muslim women; therefore, additional studies with this hard-to-reach population are warranted and will be informative to improving overall population health in the United States, an overarching priority for both public health practitioners and medical providers.