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The Cost-Effectiveness of Integrating HIV Counseling and Testing into Primary Health Care in the Ukraine

Abstract

We estimate the number of HIV cases diagnosed, costs, and cost per HIV case detected associated with integrating HIV counseling and testing (HCT) into primary health care facilities in Ukraine. The study uses a difference-in-difference design with four districts implementing the intervention compared to 20 districts where HCT were offered only at specialized HIV clinics. There was a 2.01 (95 % CI: 1.12–3.61) times increase in the number of HIV cases detected per capita in intervention districts compared to other districts. The incremental cost of the intervention was $21,017 and the incremental cost per HIV case detected was $369. The average cost per HIV case detected before the intervention was $558. Engaging primary health care facilities to provide HCT is likely desirable from an efficiency point-of-view. However, the affordability of the intervention needs to be assessed because expansion will require additional investment.

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Acknowledgments

The authors would like to thank the many partners who contributed to the successful implementation of this project: USAID mission in Ukraine, the Ministry of Health (MoH) of Ukraine; the State Service on Control over HIV/AIDS, Tuberculosis, and other Socially Dangerous Diseases; the Ukrainian Center for Disease Control, Clinton Health Access Initiative, International HIV/AIDS Alliance in Ukraine, National Academy of Post-Graduate Education named after P. L. Shupik; Institute of Epidemiology and Infectious Diseases named after V.L. Gromashevsky, and the All-Ukrainian Network of People Living with HIV. Most importantly we thank the Chernigiv Oblast Administration and Oblast AIDS Center, Trust Cabinets, and primary health care staff in pilot districts and cities of Chernigiv Oblast, in particular Dr. Mykola Deykun, Director of the Chernigiv Oblast AIDS Center, and Dr. Olga Malyuta, Head of the Outpatient Department of the Chernigiv Oblast AIDS Center, for their commitment to implementation of the new HIV testing and counseling delivery model and effective collaboration during the implementation phase. We are grateful for the useful input from participants in Abt’s Journal Author Support Group, especially Minki Chatterji. This work was supported by funding from the United States Agency for International Development (USAID) through the Health Finance and Governance Project [cooperative agreement number AID-OAA-A-12-00080]. Support for this research was also provided in part by Abt Associates Inc.’s Daniel B. McGillis Professional Development and Dissemination Grant program. BJ contributed to the study design, data analysis, and wrote the final manuscript. OD contributed to the study design, oversaw data collection, led the data analysis, and drafted the preliminary manuscript. LT and PC contributed to the study design, assisted with interpretations of the findings, and critically reviewed the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the US Government.

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Correspondence to Benjamin Johns.

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The study protocol was submitted to Abt Associates, Inc. Institutional Review Board, and was determined to be exempt from review. No primary data involving human participants were collected for this study. For this type of study formal consent is not required.

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Johns, B., Doroshenko, O., Tarantino, L. et al. The Cost-Effectiveness of Integrating HIV Counseling and Testing into Primary Health Care in the Ukraine. AIDS Behav 21, 655–664 (2017). https://doi.org/10.1007/s10461-016-1554-z

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Keywords

  • HIV counseling and testing
  • Ukraine
  • Integration
  • Primary health care
  • Cost-effectiveness