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Covid-19 impact on the cost of index testing hiv case detection in 5 indian districts
Topics in Antiviral Medicine ; 29(1):291, 2021.
Article in English | EMBASE | ID: covidwho-1250737
ABSTRACT

Background:

Index testing is a viable strategy to identify HIV cases globally and is a cornerstone of all PEPFAR programs. COVID-19 and associated lockdowns impacted access to health services including HIV testing. The financial impact of these lockdowns on HIV case detection has not been studied in-depth.

Methods:

Program ACCELERATE implemented Facility-Based Index Testing (FBIT;n=5 districts) and Community-Based Index Testing (CBIT;n=3 districts) in 2 high-burden Indian states. Retrospective costing data were obtained from expenditure records, including cost of labor, supplies/equipment, capital, training, and operational costs. Fixed and recurrent costs at the programmatic level, both overall and per district, were estimated, excluding the cost of HIV testing. On 03/24/2020, India implemented a nationwide lockdown. 10/2019- 03/2020 was classified as pre-COVID and 04/2020-09/2020 as post-COVID. To derive the unit cost per individual, the number of clients offered and accepted index testing, contacts elicited, contacts who accepted and completed HIV testing, contacts who tested positive, and new PLHIV initiated on ART were retrieved for each district.

Results:

The total programmatic cost to implement FBIT pre-COVID was $265,061, which reduced by 21.5% to $207,333 post-COVID, including startup cost for both periods. The cost to implement CBIT reduced by 63% from $160,851 to $59,605, pre and post pandemic. Pre-COVID, labor accounted for 77% of the overall implementation cost vs. 90.3% post-COVID. The total number of contacts who tested positive over 6 months of FBIT implementation reduced by 65.3% pre- to post-COVID (1048 vs 364) and by 30.6% (399 vs 277) for CBIT. Newly diagnosed PLHIV initiated on ART declined by 65.1% (895 vs 312) for FBIT and by 19.3% (311 vs 251) for CBIT. Across all districts implementing FBIT, the cost per new HIV diagnosis increased from $253 to $728, and for CBIT, from $403 to $581. The per unit cost of PLHIV initiated on ART for FBIT increased from $296 to $850, and for CBIT, from $517 to $641.

Conclusion:

The average pre-COVID cost per new HIV diagnosis through FBIT among 5 Indian districts is below the estimated cost in most LMICs. Post-COVID, the cost per diagnosis and ART initiation almost tripled for FBIT, primarily driven by a lower volume of cases. Innovative strategies, such as integrating homebased testing and HIV-self testing, may be required to offset travel restrictions imposed by COVID-19 and improve program efficiency, while minimizing exposure to SARS-CoV-2.
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Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Topics in Antiviral Medicine Year: 2021 Document Type: Article

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Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Topics in Antiviral Medicine Year: 2021 Document Type: Article