Cost of Community-Based HIV Testing Activities to Reach Saturation in Botswana
In Botswana, 85% of persons living with HIV are aware of their status. We performed an economic analysis of HIV testing activities implemented during intensive campaigns, in 11 communities, between April 2015 and March 2016, through the Botswana Combination Prevention Project. The total cost was $1,098,312, or $99,847 per community, with 60% attributable to home-based testing and 40% attributable to mobile testing. The cost per person tested was $44, and $671 per person testing positive (2017 USD). Labor costs comprised 64% of total costs. In areas of high HIV prevalence and treatment coverage, the cost of untargeted home-based testing may be inflated by the efforts required to assess the testing eligibility of clients who are HIV-positive and on ART. Home-based and mobile testing delivered though an intensive community-based campaign allowed the identification of HIV positive persons, who may not access health facilities, at a cost comparable to other studies.
KeywordsHIV HIV testing Cost Economic analysis
The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the official position of the funding agencies.
This project has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreements U2G GH000073 and U2G GH000419.
Compliance with Ethical Standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
The Botswana Combination Prevention Project study was approved by the Centers for Disease Control and Prevention Institutional Review Board (Protocol #6475) and the Botswana Health Research and Development Committee (HRDC; Institutional Review Board of the Botswana Ministry of Health and Wellness).
Informed consent was obtained from all individual participants included in the Botswana Combination Prevention Project.
- 1.UNAIDS. Botswana Country fact sheet. http://www.unaids.org/en/regionscountries/countries/botswana (2017). Accessed 18 Feb 2018
- 2.Botswana Ministry of Health. Handbook of the Botswana 2016 Integrated HIV Clinical Care guidelines. Botswana: Gaborone; 2016.Google Scholar
- 4.UNAIDS. Ending AIDS: progress towards the 90-90-90 targets. Geneva, Switzerland: UNAIDS; 2017.Google Scholar
- 5.Chang W, Chamie G, Mwai D, Clark TD, Thirumurthy H, Charlebois ED, et al. Implementation and operational research: cost and efficiency of a hybrid mobile multidisease testing approach with high HIV testing coverage in East Africa. J Acquir Immune Defic Syndr. 2016;73(3):e39–45.CrossRefGoogle Scholar
- 9.de Beer I, Chani K, Feeley FG, de Wit TFR, Sweeney-Bindels E, Mulongeni P. Assessing the costs of mobile voluntary counseling and testing at the work place versus facility based voluntary counseling and testing in Namibia. Rural Remote Health. 2015;15(4):3357.Google Scholar
- 10.Country income levels [Internet]. http://data.worldbank.org/country. Accessed 2 Sept 2016.
- 11.Table 1.1.9. Implicit price deflators for gross domestic product [Internet]. https://www.bea.gov/iTable/iTable.cfm?reqid=9&step=3&isuri=1&903=13#reqid=9&step=3&isuri=1&903=13 Accessed 2 Sept 2016.
- 14.Bautista-Arredondo S, Sosa-Rubi SG, Opuni M, Contreras-Loya D, Kwan A, Chaumont C, et al. Costs along the HTC and PMTCT service cascades: findings from Kenya, South Africa, and Zambia. Rwanda: Aids; 2016.Google Scholar
- 15.World Health Organization. Consolidated guidelines on HIV testing services: 5Cs: consent, confidentiality, counselling, correct results and connection. Geneva: WHO; 2015.Google Scholar
- 16.Johnson C, Dalal S, Baggaley R, Hogan D, Parrott G, Mathews R, et al. Systematic review of HIV testing costs in high and low income settings. Consolidated guidelines on HIV testing services: 5Cs: consent, confidentiality, counselling, correct results and connection. ANNEX 5. Geneva: World Health Organization; 2015.Google Scholar