ABSTRACT
Background: The challenge is to make all HIV-infected people aware of their status so that they may prevent the transmission of HIV to others. Only 25–30% of the people who are HIV positive in India are aware of their HIV status. Guntur district has a high epidemic potential with established transmission among the general population. The objective of the study was to study the socio demographic profile and HIV positivity rates among clients visiting an Integrated Counselling and Testing Centre (ICTC).Methods: This descriptive study is based on secondary data from the records of the ICTC. The data is entered and analysed with MS Office Excel and EPI Info statistical package. Important findings were tested for statistical significance at 5% level of significance.Results: Of the 6940 clients attending the ICTC, 43.34% are antenatal women (HIV positivity of 0.27%). Of the rest, provider initiated clients are 94.02% (HIV positivity 4.38%) and client initiated 5.9% (HIV positivity 20%). The difference of HIV positivity is highly significant (p<0.000001). 61.1% of the clients were found to be between the ages 25 to 49 years. Among the client initiated, more women (7.4%) were seen to be attending the ICTC (p<0.05). High risk professions identified were hotel workers (7.3% HIV positive), local transport workers (6.01%) and petty business (6.22%). Housewives were found to have 3.2% HIV positivity.Conclusions: Self-referral to ICTC is still very poor. The epidemic is shifting to the general populations. HIV/AIDs education efforts aimed at the population in general must be increased.
ABSTRACT
Background: Provider-initiated HIV counseling and testing (PIHIVCT) is an important intervention that improves the access to care to HIV-infected patients and subsequently contributes to the success of national HIV/AIDS control efforts. However, in Thailand, the cost-effectiveness of this program is unknown. Objective: Determine the incremental cost-effectiveness ratios (ICER) in terms of Thai Baht per Quality Adjusted Life Year (QALY) of PIHIVCT for outpatient department (OPD) patients in community hospitals of Thailand compared with the current practice. Methods: A model-based health economic evaluation study was conducted based on results from cluster randomized controlled trials in 16 community hospitals of Thailand. The Markov model and the probabilistic sensitivity analysis were used. One-thousand two-hundred seventy-seven HIV-infected patients completed questionnaires on their household expenditure and quality of life using the visual analog scale. Results: In social perspectives, the PIHIVCT program increased a patient’s life span by 5.18 days or 4.15 qualityadjusted days per OPD case and the ICER was 63,588 Baht per QALY gained. The subgroup analysis showed that the PIHIVCT program would be cost-effective for cases younger than 50 years if the ceiling threshold of willing to pay equaled the per capita Gross Domestic Product (GDP). However, this intervention would be cost-effective for all cases of 13-64 year old if the ceiling threshold equaled three times of GDP. Conclusion: The provider-initiated HIV counseling and testing program for OPD patients is more cost-effective than the current practice and should be implemented in health care setting in Thailand.