Related Experiment Video
Updated: Mar 13, 2026
Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Implementation and Operational Research: Cost and Efficiency of a Hybrid Mobile Multidisease Testing Approach With
Wei Chang1, Gabriel Chamie, Daniel Mwai
1*Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA; †Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA; ‡School of Economics, University of Nairobi, Nairobi, Kenya; §Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC; ‖Center for AIDS Prevention Studies, University of California, San Francisco, CA; ¶Department of Biostatistics, University of California, Berkeley, CA; #Infectious Disease Research Collaboration, Kampala, Uganda; **Kenya Medical Research Institute, Nairobi, Kenya; ††Division of HIV Prevention, Makerere University Joint AIDS Program, Kampala, Uganda; ‡‡Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA; and §§Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Background:
In 2013-2014, we achieved 89% adult HIV testing coverage using a hybrid testing approach in 32 communities in Uganda and Kenya (SEARCH: NCT01864603). To inform scalability, we sought to determine: (1) overall cost and efficiency of this approach; and (2) costs associated with point-of-care (POC) CD4 testing, multidisease services, and community mobilization.
Methods:
We applied microcosting methods to estimate costs of population-wide HIV testing in 12 SEARCH trial communities. Main intervention components of the hybrid approach are census, multidisease community health campaigns (CHC), and home-based testing for CHC nonattendees. POC CD4 tests were provided for all HIV-infected participants. Data were extracted from expenditure records, activity registers, staff interviews, and time and motion logs.
Results:
The mean cost per adult tested for HIV was $20.5 (range: $17.1-$32.1) (2014 US$), including a POC CD4 test at $16 per HIV+ person identified. Cost per adult tested for HIV was $13.8 at CHC vs. $31.7 by home-based testing. The cost per HIV+ adult identified was $231 ($87-$1245), with variability due mainly to HIV prevalence among persons tested (ie, HIV positivity rate). The marginal costs of multidisease testing at CHCs were $1.16/person for hypertension and diabetes, and $0.90 for malaria. Community mobilization constituted 15.3% of total costs.
Conclusions:
The hybrid testing approach achieved very high HIV testing coverage, with POC CD4, at costs similar to previously reported mobile, home-based, or venue-based HIV testing approaches in sub-Saharan Africa. By leveraging HIV infrastructure, multidisease services were offered at low marginal costs.
