Background: In the face of the dual TB/HIV epidemic, the ProTEST
Initiative was one of the first to demonstrate the feasibility of
providing collaborative TB/HIV care for people living with HIV (PLWH) in
poor settings. The ProTEST Initiative facilitated collaboration between
service providers. Voluntary counselling and testing (VCT) acted as the
entry point for services including TB screening and preventive therapy,
clinical treatment for HIV-related disease, and home-based care (HBC),
and a hospice. This paper estimates the costs of the ProTEST Initiative
in two sites in urban Zambia, prior to the introduction of
anti-retroviral therapy. Methods: Annual financial and economic
providers' costs and output measures were collected in 2000–2001.
Estimates are made of total costs for each component and average costs
per: person reached by ProTEST; VCT pre-test counselled, tested and
completed; isoniazid preventive therapy started and completed; clinic
visit; HBC patient; and hospice admission and bednight.
Results: Annual core ProTEST costs were (in 2007 US dollars) $84,213 in
Chawama and $31,053 in Matero. The cost of coordination was 4%–5% of
total site costs ($1–$6 per person reached). The largest cost component
was voluntary counselling and testing (56%) in Chawama and the clinic in
Matero (50%), where VCT clients had higher HIV prevalences and more
advanced HIV. Average costs were lower for all components in the larger
site. The cost per HBC patient was $149, and that per hospice bednight
Conclusion: This study shows that coordinating an integrated and
comprehensive package of services for PLWH is relatively inexpensive.
The lessons learnt in this study are still applicable today in the era
of ART, as these services must still be provided as part of the
continuum of care for people living with HIV.
Terris-Prestholt, F.; Kumaranayake, L.; Ginwalla, R.; Ayles, H.; Kayawe, I.; Hillery, M.; Godfrey-Faussett, P. Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian ProTEST Initiative. Cost Effectiveness and Resource Allocation (2008) 6 (1) 2. [DOI: 10.1186/1478-7547-6-2]
Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian ProTEST Initiative.