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Methods, outcomes, and costs of a 2.5 year comprehensive facility-and community-based HIV testing intervention in Bukoba Municipal Council, Tanzania, 2014-2017.
Cham, Haddi Jatou; MacKellar, Duncan; Maruyama, Haruka; Rwabiyago, Oscar Ernest; Msumi, Omari; Steiner, Claire; Kundi, Gerald; Weber, Rachel; Byrd, Johnita; Suraratdecha, Chutima; Mengistu, Tewodaj; Churi, Eliufoo; Pals, Sherri; Madevu-Matson, Caitlin; Alexander, Geofrey; Porter, Sarah; Kazaura, Kokuhumbya; Mbilinyi, Deogratius; Morales, Fernando; Rutachunzibwa, Thomas; Justman, Jessica; Rwebembera, Anath.
Afiliação
  • Cham HJ; Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
  • MacKellar D; Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
  • Maruyama H; ICAP at Columbia University, Dar es Salaam, Tanzania.
  • Rwabiyago OE; U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania.
  • Msumi O; ICAP at Columbia University, Dar es Salaam, Tanzania.
  • Steiner C; ICAP at Columbia University, Dar es Salaam, Tanzania.
  • Kundi G; ICAP at Columbia University, Dar es Salaam, Tanzania.
  • Weber R; U.S. Centers for Disease Control and Prevention, Yaounde, Cameroon.
  • Byrd J; ICF International, Atlanta, Georgia, United States of America.
  • Suraratdecha C; Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
  • Mengistu T; Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
  • Churi E; Henry Jackson Foundation Medical Research International, Mbeya, Tanzania.
  • Pals S; Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
  • Madevu-Matson C; ICAP at Columbia University, New York, New York, United States of America.
  • Alexander G; Tanzania Health Promotion Support, Dar es Salaam, Tanzania.
  • Porter S; Division of Global HIV and TB, National Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
  • Kazaura K; U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania.
  • Mbilinyi D; United Nations Children's Fund, Dar es Salaam, Tanzania.
  • Morales F; ICAP at Columbia University, Dar es Salaam, Tanzania.
  • Rutachunzibwa T; Ministry of Health, Community Development, Gender, Elderly and Children, Bukoba, Tanzania.
  • Justman J; Tanzania Health Promotion Support, Dar es Salaam, Tanzania.
  • Rwebembera A; National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania.
PLoS One ; 14(5): e0215654, 2019.
Article em En | MEDLINE | ID: mdl-31048912
ABSTRACT
To diagnose ≥90% HIV-infected residents (diagnostic coverage), the Bukoba Combination Prevention Evaluation (BCPE) implemented provider-initiated (PITC), home- (HBHTC), and venue-based (VBHTC) HIV testing and counseling (HTC) intervention in Bukoba Municipal Council, a mixed urban and rural lake zone community of 150,000 residents in Tanzania. This paper describes the methods, outcomes, and incremental costs of these HTC interventions. PITC was implemented in outpatient department clinics in all eight public and three faith-based health facilities. In clinics, lay counselors routinely screened and referred eligible patients for HIV testing conducted by HTC-dedicated healthcare workers. In all 14 wards, community teams offered HTC to eligible persons encountered at 31,293 home visits and at 79 male- and youth-frequented venues. HTC was recommended for persons who were not in HIV care or had not tested in the prior 90 days. BCPE conducted 133,695 HIV tests during the 2.5 year intervention (PITC 88,813, 66%; HBHTC 27,407, 21%; VBHTC 17,475, 13%). Compared with other strategies, PITC conducted proportionally more tests among females (65%), and VBHTC conducted proportionally more tests among males (69%) and young-adults aged 15-24 years (42%). Of 5,550 (4.2% of all tests) HIV-positive tests, 4,143 (75%) clients were newly HIV diagnosed, including 1,583 males and 881 young adults aged 15-24 years. Of HIV tests conducted 3.7%, 1.8%, and 2.1% of PITC, HBHTC, and VBHTC clients, respectively, were newly HIV diagnosed; PITC accounted for 79% of all new diagnoses. Cost per test (per new diagnosis) was $4.55 ($123.66), $6.45 ($354.44), and $7.98 ($372.67) for PITC, HBHTC, and VBHTC, respectively. In a task-shifting analysis in which lay counselors replaced healthcare workers, estimated costs per test (per new diagnosis) would have been $3.06 ($83.15), $ 4.81 ($264.04), and $5.45 ($254.52), for PITC, HBHTC, and VBHTC, respectively. BCPE models reached different target groups, including men and young adults, two groups with consistently low coverage. Implementation of multiple models is likely necessary to achieve ≥90% diagnostic coverage.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Características de Residência / Programas de Rastreamento / Avaliação de Resultados em Cuidados de Saúde / Custos e Análise de Custo Tipo de estudo: Health_economic_evaluation / Prognostic_studies / Screening_studies Limite: Adolescent / Adult / Female / Humans / Male / Middle aged País como assunto: Africa Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Características de Residência / Programas de Rastreamento / Avaliação de Resultados em Cuidados de Saúde / Custos e Análise de Custo Tipo de estudo: Health_economic_evaluation / Prognostic_studies / Screening_studies Limite: Adolescent / Adult / Female / Humans / Male / Middle aged País como assunto: Africa Idioma: En Ano de publicação: 2019 Tipo de documento: Article