Comparative evaluation of different approaches of Voluntary Counseling and Testing VCT in Tanzania:

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Comparative evaluation of different approaches of
Voluntary Counseling and Testing (VCT) in
Tanzania uptake, quality, and costs

• Eric Lugada MD, PhD
• August 15th, 2006

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Acknowledgement - Co-authors

• 1. Kenneth Lema
• 1. Timothy Wakabi
• 1. Zaharini Karungwa
• 1. Grace Mbekem
• 2. Marc Pechevis
• 2. Marie-Laure Kurzinger
• 2. Anne Reeler
• 2. Joseph Saba
• 3. Peris Urassa
• 3. Rowland Swai
• 4. Jeff Richardson
• 5. James G Kahn

• Axios Dar es Salaaam, Tanzania
• Axios Paris, France
• National AIDS Control program-MOH, Tanzania
• Abbot Fund Chicago, USA
• Institute for Health policy studies- University
  of California, San Francisco, USA

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Acknowledgment - Partners

• National AIDS Control Program-Ministry of Health
  Tanzania
• AMREF-Tanzania
• Regional and district medical officers
• Participating facilities

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Background

• VCT is primarily offered as a stand alone service
  and is not integrated with other health services
  even when offered at health facilities
• HIV prevalence in Tanzania is 7 and 21 in
  health facilities yet less than 10 have tested
  for HIV infection

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Introduction

• With support from Axios and funding from the
  Abbott Fund, the Tanzanian government implemented
  integrated VCT in 12 regions opt-out testing
  during routine outpatient care
• This study compares integrated VCT, co-situated
  VCT and free-standing VCT, with the hope of
  informing VCT strategies in sub-Saharan Africa

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Method

• Comparison of integrated vs co-situated vs
  free-standing VCT, across 27 districts in
  Tanzania, in 65 randomly selected facilities
• Client characteristics and VCT uptake rates were
  derived from program monitoring data
• Quality of HIV testing, linkage to care, and cost
  were assessed by interviews and observation

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Overview of VCT delivery methods
HF-health facility
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Clients served by age
P lt0.001
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VCT delivery method by gender
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VCT uptake by method of delivery
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Proportion of HIV per 1000 OPD visits
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Immediate link to care given co-trimoxazole
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Link to care referred to CTC for ARV therapy
CTC- care and treatment clinics
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HIV test quality control
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Comparative cost of VCT delivery methods
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Discussion

• All three methods of delivering VCT services
  showed high acceptance rates to test although the
  proportion of OPD visits with testing was low
• Lower level facilities (dispensaries) detected
  more HIV per 1000, need to strengthen their
  ability to offer care
• Integrated VCT service resulted in immediate and
  routine referral of HIV infected patients to
  available care
• Integrated VCT cost substantially less per HIV
  infected person identified compared to other
  methods

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Conclusion

• Integrated VCT can cost less and effectively
  links infected persons to available care
• Outpatient consultation without VCT offered
  routinely is a missed opportunity for effective
  HIV/AIDS prevention, care and treatment services

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Integrated VCT sites in Tanzania
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THANK YOU
eric.lugada_at_axiosfoundation.org