Cost Analysis Of Facility-Based HIV Testing Models In Kenya; A Case Of Riruta Health Centre

Abstract

HIV testing is the first and essential step in HIV management. Awareness of HIV status is an important step in linking people to prevention, care and treatment services and reducing possible transmission of HIV. Despite this step being key in HIV management, there exist people living with HIV in Kenya who do not know their HIV status. There is need to identify cost effective HIV testing models that target to reach the unreached population and help reduce risk of HIV transmission. The aim of the study was to document HIV testing models and estimate unit cost of facility-based HIV testing. This study was conducted at Riruta Health Centre, Nairobi County. Process maps were used to document HIV testing and to capture all the resources used at the facility. Testing models were established through key informant interviews. Cost for HIV testing was estimated by considering cost of HIV test kits, consumables, space, furniture and cost of human resource. Overhead costs were applied at 10% of the total costs. An abstraction tool was used to collect retrospective data for all children and adults tested for HIV at the facility between July 2017-June 2018. Facility-based HIV testing was predominant at facility. However, it participated in community HIV testing when there was planned outreach by other institutions. A total of 30,665 HIV tests were done at the Voluntary Counselling and Testing Centers (VCT) and 237 at Antenatal Clinic (ANC) of the total tests done 600 were reactive. No data on HIV self-testing was documented for the period under study. Costs of test kits and consumables per a non-reactive test was Ksh189.30 compared with Ksh541.40 for a reactive test for general population. Testing costs at ANC were higher; Ksh.221.26 for a non-reactive test compared to Ksh.573.33 for a reactive test using HIV Syphilis duo test kit. There was a difference in the cost of HIV test based on the cadre of officer that performed the test; Ksh70.44 for HTS counselor compared Ksh104.64 for a registered Nurse. Costing information is useful for resource allocation and carrying out economic evaluations of HIV testing programs.