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Paper on cost and outcomes of voluntary counseling and testing in Indonesia to appear in Tropical Medicine and International Health (TMIH)

04 OCTOBER 2010

Adiatma Y.M Siregar and Rob Baltussen published a paper on costs and outcomes of VCT delivery models in the context of scaling up services in Indonesia. This paper is part of Adiatma's PhD project on Economic analysis of HIV/AIDS control among injecting drug users (IDUs) in Bandung, Indonesia.

ABSTRACT
RESEARCHERS: Adiatma Y.M Siregar, Dindin Komarudin, Rudi Wisaksana, Reinout van Crevel, Rob Baltussen.
TITLE: Costs and outcomes of VCT delivery models in the context of scaling up services in Indonesia.
OBJECTIVE: To evaluate costs and outcomes of VCT service delivery models in an urban setting in Indonesia
METHODS: We collected primary data on utilization, costs, and outcomes of VCT services in a hospital clinic (568 clients), HIV community clinic (28 clients), STI community clinic (784 clients), and prison clinic (574 clients) in Bandung, Indonesia, in the period January 2008 – April 2009.
RESULTS: The hospital clinic diagnosed the highest proportion and absolute number of HIV infections, but with the lowest average CD4 cell count and with the highest associated travelling and waiting time. The prison clinic detected fewer cases, but at an earlier stage, and all enrolled in HIV-care. The community clinics detected the smallest number of cases, and only 0-8% enrolled in HIV care. The unit cost per VCT was highest in the hospital clinic (US$74), followed by the STI community clinic (US$65), the HIV community clinic (US$39) and the prison (US$23).
CONCLUSION: We propose a reorientation of the delivery models for VCT and related HIV/AIDS treatment in this setting. We call for the scaling up of community clinics for VCT to improve access, promote earlier detection and to perform (early) treatment activities. This would reduce the burden of the hospital clinic to orient itself towards the treatment of AIDS patients. This is one of very few studies addressing this issue in Asia and the first of its kind in Indonesia, which has a rapidly growing HIV-epidemic. The conceptual framework and overall conclusions may also relevant to other low-income settings.


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