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Costes y resultados de modelos de entrega del aconsejamiento y prueba voluntarios dentro del contexto del llevar a escala los servicios en Indonesia
Author(s) -
Siregar Adiatma Y. M.,
Komarudin Dindin,
Wisaksana Rudi,
van Crevel Reinout,
Baltussen Rob
Publication year - 2011
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2010.02675.x
Subject(s) - medicine , prison , context (archaeology) , human immunodeficiency virus (hiv) , service delivery framework , family medicine , developing country , emergency department , emergency medicine , service (business) , nursing , psychology , economic growth , economics , paleontology , economy , criminology , biology
Summary Objective To evaluate costs and outcomes of voluntary counselling and testing (VCT) service delivery models in urban 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), sexually transmitted infection (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 be relevant to other low‐income settings.