Chang, W., Chamie, G., Mwai, D., et al. Journal of Acquired Immune Deficiency Syndromes (2016), E-publication ahead of print. doi: 10.1097/QAI.0000000000001141.
This study examined the costs of community-based HIV testing and counseling provided through multi-disease testing campaigns in 32 Ugandan and Kenyan communities (2013–2014). The initiative consisted of a community census, followed by two weeks of a community health campaign (CHC) including public screening for HIV, tuberculosis, malaria, hypertension, and diabetes. After CHC, individuals who had not yet accessed testing were identified and offered home-based testing (HBT). Researchers examined the testing costs in 12 of the 32 communities. The average cost for implementing the approach was USD$92,403 per community. The average cost per adult test was USD$20.50, including CD4 test for those testing positive. For each HIV-positive adult, the associated cost was $230.70, although costs varied among study communities ($87–$1,245) given variations in HIV incidence across settings. Testing during CHC cost $13.80 for each adult, while HBT cost $31.70. The cost per HIV-positive diagnosis was $153.30 for CHC and $298.50 for HBT. During CHC, 74 percent of adult community members were tested; follow-up HBT increased coverage to 89 percent. While costs associated with CHC testing were lower, more HIV-positive individuals were identified through HBT. The authors suggested using these findings to inform programs seeking to scale up HIV testing, and to support decisions on resource distribution and policies.