A costing analysis of B-GAP: index-linked HIV testing for children and adolescents in Zimbabwe

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dc.contributor.authorVasantharoopan, Arthi
dc.contributor.authorMaheswaran, Hendramoorthy
dc.contributor.authorSimms, Victoria
dc.contributor.authorDziva Chikwari, Chido
dc.contributor.authorChigwenah, Tariro
dc.contributor.authorChikodzore, Rudo
dc.contributor.authorNyathi, Khulamuzi
dc.contributor.authorNcube, Gertrude
dc.contributor.authorFerrand, Rashida A
dc.contributor.authorGuinness, Lorna
dc.date.accessioned2021-10-26T09:02:59Z
dc.date.available2021-10-26T09:02:59Z
dc.date.issued2021-10-12
dc.date.updated2021-10-17T03:13:02Z
dc.description.abstractBackground By testing children and adolescents of HIV positive caretakers, index-linked HIV testing, a targeted HIV testing strategy, has the ability to identify high risk children and adolescents earlier and more efficiently, compared to blanket testing. We evaluated the incremental cost of integrating index-linked HIV testing via three modalities into HIV services in Zimbabwe. Methods A mixture of bottom-up and top-down costing was employed to estimate the provider cost per test and per HIV diagnosis for 2–18 year olds, through standard of care testing, and the incremental cost of index-linked HIV testing via three modalities: facility-based testing, home-based testing by a healthcare worker, and testing at home by the caregiver using an oral mucosal transudate test. In addition to interviews, direct observation and study process data, facility registries were abstracted to extract outcome data and resource use. Costs were converted to 2019 constant US$. Results The average cost per standard of care test in urban facilities was US$5.91 and US$7.15 at the rural facility. Incremental cost of an index-linked HIV test was driven by the uptake and number of participants tested. The lowest cost approach in the urban setting was home-based testing (US$6.69) and facility-based testing at the rural clinic (US$5.36). Testing by caregivers was almost always the most expensive option (rural US$62.49, urban US$17.49). Conclusions This is the first costing analysis of index-linked HIV testing strategies. Unit costs varied across sites and with uptake. When scaling up, alternative testing solutions that increase efficiency such as index-linked HIV testing of the entire household, as opposed to solely targeting children/adolescents, need to be explored.en_US
dc.identifier.apacitationVasantharoopan, A., Maheswaran, H., Simms, V., Dziva Chikwari, C., Chigwenah, T., Chikodzore, R., ... Guinness, L. (2021). A costing analysis of B-GAP: index-linked HIV testing for children and adolescents in Zimbabwe. <i>BMC Health Services Research</i>, 21(1), 1082. http://hdl.handle.net/11427/35292en_ZA
dc.identifier.chicagocitationVasantharoopan, Arthi, Hendramoorthy Maheswaran, Victoria Simms, Chido Dziva Chikwari, Tariro Chigwenah, Rudo Chikodzore, Khulamuzi Nyathi, Gertrude Ncube, Rashida A Ferrand, and Lorna Guinness "A costing analysis of B-GAP: index-linked HIV testing for children and adolescents in Zimbabwe." <i>BMC Health Services Research</i> 21, 1. (2021): 1082. http://hdl.handle.net/11427/35292en_ZA
dc.identifier.citationVasantharoopan, A., Maheswaran, H., Simms, V., Dziva Chikwari, C., Chigwenah, T., Chikodzore, R., Nyathi, K. & Ncube, G. et al. 2021. A costing analysis of B-GAP: index-linked HIV testing for children and adolescents in Zimbabwe. <i>BMC Health Services Research.</i> 21(1):1082. http://hdl.handle.net/11427/35292en_ZA
dc.identifier.ris TY - Journal Article AU - Vasantharoopan, Arthi AU - Maheswaran, Hendramoorthy AU - Simms, Victoria AU - Dziva Chikwari, Chido AU - Chigwenah, Tariro AU - Chikodzore, Rudo AU - Nyathi, Khulamuzi AU - Ncube, Gertrude AU - Ferrand, Rashida A AU - Guinness, Lorna AB - Background By testing children and adolescents of HIV positive caretakers, index-linked HIV testing, a targeted HIV testing strategy, has the ability to identify high risk children and adolescents earlier and more efficiently, compared to blanket testing. We evaluated the incremental cost of integrating index-linked HIV testing via three modalities into HIV services in Zimbabwe. Methods A mixture of bottom-up and top-down costing was employed to estimate the provider cost per test and per HIV diagnosis for 2–18 year olds, through standard of care testing, and the incremental cost of index-linked HIV testing via three modalities: facility-based testing, home-based testing by a healthcare worker, and testing at home by the caregiver using an oral mucosal transudate test. In addition to interviews, direct observation and study process data, facility registries were abstracted to extract outcome data and resource use. Costs were converted to 2019 constant US$. Results The average cost per standard of care test in urban facilities was US$5.91 and US$7.15 at the rural facility. Incremental cost of an index-linked HIV test was driven by the uptake and number of participants tested. The lowest cost approach in the urban setting was home-based testing (US$6.69) and facility-based testing at the rural clinic (US$5.36). Testing by caregivers was almost always the most expensive option (rural US$62.49, urban US$17.49). Conclusions This is the first costing analysis of index-linked HIV testing strategies. Unit costs varied across sites and with uptake. When scaling up, alternative testing solutions that increase efficiency such as index-linked HIV testing of the entire household, as opposed to solely targeting children/adolescents, need to be explored. DA - 2021-10-12 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Health Services Research KW - HIV KW - Index-linked HIV testing KW - Community-based HIV testing KW - Home-based HIV testing KW - HIV assisted-testing KW - Costing analysis LK - https://open.uct.ac.za PY - 2021 T1 - A costing analysis of B-GAP: index-linked HIV testing for children and adolescents in Zimbabwe TI - A costing analysis of B-GAP: index-linked HIV testing for children and adolescents in Zimbabwe UR - http://hdl.handle.net/11427/35292 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12913-021-07070-3
dc.identifier.urihttp://hdl.handle.net/11427/35292
dc.identifier.vancouvercitationVasantharoopan A, Maheswaran H, Simms V, Dziva Chikwari C, Chigwenah T, Chikodzore R, et al. A costing analysis of B-GAP: index-linked HIV testing for children and adolescents in Zimbabwe. BMC Health Services Research. 2021;21(1):1082. http://hdl.handle.net/11427/35292.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentHealth Economics Uniten_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Health Services Researchen_US
dc.source.journalissue1en_US
dc.source.journalvolume21en_US
dc.source.pagination1082en_US
dc.source.urihttps://bmchealthservres.biomedcentral.com/
dc.subjectHIVen_US
dc.subjectIndex-linked HIV testingen_US
dc.subjectCommunity-based HIV testingen_US
dc.subjectHome-based HIV testingen_US
dc.subjectHIV assisted-testingen_US
dc.subjectCosting analysisen_US
dc.titleA costing analysis of B-GAP: index-linked HIV testing for children and adolescents in Zimbabween_US
dc.typeJournal Articleen_US
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