Comparative evaluation of different
approaches of Voluntary Counseling and
Testing (VCT) in Tanzania: uptake, quality,
and costs
Eric Lugada MD, PhD
August 15th, 2006
Acknowledgement - Co-authors
1.
1.
1.
1.
2.
2.
2.
2.
3.
3.
4.
5.
Kenneth Lema
Timothy Wakabi
Zaharini Karungwa
Grace Mbekem
Marc Pechevis
Marie-Laure Kurzinger
Anne Reeler
Joseph Saba
Peris Urassa
Rowland Swai
Jeff Richardson
James G Kahn
www.axios-group.com
1. Axios Dar es Salaaam,
Tanzania
2. Axios Paris, France
3. National AIDS Control
program-MOH, Tanzania
4. Abbot Fund Chicago, USA
5. Institute for Health policy
studies- University of
California, San Francisco,
USA
Acknowledgment - Partners
 National AIDS Control Program-Ministry of
Health Tanzania
 AMREF-Tanzania
 Regional and district medical officers
 Participating facilities
www.axios-group.com
Background
 VCT is primarily offered as a stand alone service
and is not integrated with other health services
even when offered at health facilities
 HIV prevalence in Tanzania is 7% and 21% in
health facilities yet less than 10% have tested for
HIV infection
www.axios-group.com
Introduction
 With support from Axios and funding from the
Abbott Fund, the Tanzanian government
implemented integrated VCT in 12 regions:
opt-out testing during routine outpatient care
 This study compares integrated VCT, cosituated VCT and free-standing VCT, with the
hope of informing VCT strategies in subSaharan Africa
www.axios-group.com
Method
 Comparison of integrated vs co-situated vs freestanding VCT, across 27 districts in Tanzania, in
65 randomly selected facilities
 Client characteristics and VCT uptake rates
were derived from program monitoring data
 Quality of HIV testing, linkage to care, and cost
were assessed by interviews and observation
www.axios-group.com
Overview of VCT delivery methods
Method of VCT delivery
Characteristics
*HF
Integrated
*HF
co-situated
Free
standing**
Total
Number of sites
24
29
12
65
Rural proportion
63%
59%
42%
57%
Total OPD visits*
482,289
736,572
34,713
1,253,574
15,762
23,727
26,847
66,336
3,881
5,579
2,660
12,120
25%
24%
10%
18%
Number HIV tested
Number HIV+
HIV Prevalence
*HF-health facility
www.axios-group.com
Clients served by age
Age
N
HF
Integrated
HF
co-situated
Freestanding
Total
14,999
45,882
42,704
103,585
15 to 19 years
10%
13%
20%
15%
20 to 24 years
21%
27%
36%
30%
25 to 39 years
50%
43%
35%
41%
40+ years
19%
17%
9%
14%
P <0.001
www.axios-group.com
VCT delivery method by gender
www.axios-group.com
VCT uptake by method of delivery
100%
99.4% 96.4%
99.4%
92.6%
99.0% 99.9%
Percent
80%
60%
40%
20%
0%
HF Integrated
HF Co-situated
Free-standing
VCT delivery method
www.axios-group.com
Acceptance to test
Post test counselled
HIV+ detected / 1000 OPD
visits
Proportion of HIV+ per 1000 OPD visits
30
25
26
20
12
7
10
7
5
0
Dispensary
Health Centre
Facility level
HF Integrated
www.axios-group.com
HF Co-situated
Hospital
Percent of HIV+ clients
Immediate link to care – given co-trimoxazole
100%
50%
0%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month (2005)
HF Integrated
www.axios-group.com
HF Co-situated
Free standing
Percent of HIV+ clients
Link to care – referred to CTC for ARV therapy
70%
50%
30%
10%
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Month (2005)
HF Integrated
www.axios-group.com
HF Co-situated
Free standing
CTC- care and treatment clinics
Nov
Dec
Percent of sites with QC
HIV test quality control
100%
100%
50%
91%
33%
0%
HF Integrated
HF Co-situated
VCT delivery method
www.axios-group.com
Free standing
Comparative cost of VCT delivery methods
Cost per
VCT client
HIV+ rate
Cost per
HIV+ person
identified
www.axios-group.com
Integrated
Co-situated
Freestanding
$3.60
$7.20
$6.70
25%
24%
10%
$14.40
$30
$67
Discussion
 All three methods of delivering VCT services showed
high acceptance rates to test although the proportion of
OPD visits with testing was low
 Lower level facilities (dispensaries) detected more HIV+
per 1000, need to strengthen their ability to offer care
 Integrated VCT service resulted in immediate and routine
referral of HIV infected patients to available care
 Integrated VCT cost substantially less per HIV infected
person identified compared to other methods
www.axios-group.com
Conclusion
 Integrated VCT can cost less and
effectively links infected persons to
available care
 Outpatient consultation without VCT
offered routinely is a missed opportunity
for effective HIV/AIDS prevention, care
and treatment services
www.axios-group.com
Integrated VCT sites in Tanzania
www.axios-group.com
THANK YOU
[email protected]
www.axios-group.com