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Integrating tuberculosis and HIV services for people living with HIV: costs of the Zambian ProTEST Initiative.

Terris-Prestholt F, Kumaranayake L, Ginwalla R, Ayles H, Kayawe I, Hillery M, Godfrey-Faussett P - Cost Eff Resour Alloc (2008)

Bottom Line: The cost per HBC patient was $149, and per hospice bednight was $24.This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive.The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

View Article: PubMed Central - HTML - PubMed

Affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Fern.Terris-Prestholt@lshtm.ac.uk

ABSTRACT

Background: In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH) in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT) acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC), and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy.

Methods: Annual financial and economic providers costs and output measures were collected in 2000-2001. Estimates are made of total costs for each component and average costs per: person reached by ProTEST; VCT pre-test counselled, tested and completed; isoniazid preventive therapy started and completed; clinic visit; HBC patient; and hospice admission and bednight.

Results: Annual core ProTEST costs were (in 2007 US dollars) $84,213 in Chawama and $31,053 in Matero. The cost of coordination was 4%-5% of total site costs ($1-$6 per person reached). The largest cost component in Chawama was voluntary counselling and testing (56%) and the clinic in Matero (50%), where VCT clients had higher HIV-prevalences and more advanced HIV. Average costs were lower for all components in the larger site. The cost per HBC patient was $149, and per hospice bednight was $24.

Conclusion: This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

No MeSH data available.


Related in: MedlinePlus

ProTEST Zambia and its referral systems. Arrows depict the direction of referrals; VCT: Voluntary counselling and testing; YFS: Youth friendly services; PLWH: People living with HIV; STI: sexually transmitted infection.
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Figure 1: ProTEST Zambia and its referral systems. Arrows depict the direction of referrals; VCT: Voluntary counselling and testing; YFS: Youth friendly services; PLWH: People living with HIV; STI: sexually transmitted infection.

Mentions: The aim of the coordination component was to strengthen collaboration and channels of communication between traditionally vertical TB and HIV services that were serving much of the same population. The main tangible activity was meetings among the different service providers to coordinate their services and strengthen their mutual referral systems (Figure 1). Lunch and transportation were provided to participants. Service providers attending meetings included representatives from all core and affiliated services and other groups working on HIV or TB such as support groups for PLWH, government department of health employees, and other community organisations.


Integrating tuberculosis and HIV services for people living with HIV: costs of the Zambian ProTEST Initiative.

Terris-Prestholt F, Kumaranayake L, Ginwalla R, Ayles H, Kayawe I, Hillery M, Godfrey-Faussett P - Cost Eff Resour Alloc (2008)

ProTEST Zambia and its referral systems. Arrows depict the direction of referrals; VCT: Voluntary counselling and testing; YFS: Youth friendly services; PLWH: People living with HIV; STI: sexually transmitted infection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2266707&req=5

Figure 1: ProTEST Zambia and its referral systems. Arrows depict the direction of referrals; VCT: Voluntary counselling and testing; YFS: Youth friendly services; PLWH: People living with HIV; STI: sexually transmitted infection.
Mentions: The aim of the coordination component was to strengthen collaboration and channels of communication between traditionally vertical TB and HIV services that were serving much of the same population. The main tangible activity was meetings among the different service providers to coordinate their services and strengthen their mutual referral systems (Figure 1). Lunch and transportation were provided to participants. Service providers attending meetings included representatives from all core and affiliated services and other groups working on HIV or TB such as support groups for PLWH, government department of health employees, and other community organisations.

Bottom Line: The cost per HBC patient was $149, and per hospice bednight was $24.This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive.The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

View Article: PubMed Central - HTML - PubMed

Affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Fern.Terris-Prestholt@lshtm.ac.uk

ABSTRACT

Background: In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH) in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT) acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC), and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy.

Methods: Annual financial and economic providers costs and output measures were collected in 2000-2001. Estimates are made of total costs for each component and average costs per: person reached by ProTEST; VCT pre-test counselled, tested and completed; isoniazid preventive therapy started and completed; clinic visit; HBC patient; and hospice admission and bednight.

Results: Annual core ProTEST costs were (in 2007 US dollars) $84,213 in Chawama and $31,053 in Matero. The cost of coordination was 4%-5% of total site costs ($1-$6 per person reached). The largest cost component in Chawama was voluntary counselling and testing (56%) and the clinic in Matero (50%), where VCT clients had higher HIV-prevalences and more advanced HIV. Average costs were lower for all components in the larger site. The cost per HBC patient was $149, and per hospice bednight was $24.

Conclusion: This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

No MeSH data available.


Related in: MedlinePlus