Costs of implementing universal test and treat in three correctional facilities in South Africa and Zambia
Universal test and treat (UTT) is a population-based strategy that aims to ensure widespread HIV testing and rapid antiretroviral therapy (ART) for all who have tested positive regardless of CD4 count to decrease HIV incidence and improve health outcomes. Little is known about the specific resources...
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| Veröffentlicht in: | PloS one 2022-08, Vol.17 (8), p.e0272595 |
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| description | Universal test and treat (UTT) is a population-based strategy that aims to ensure widespread HIV testing and rapid antiretroviral therapy (ART) for all who have tested positive regardless of CD4 count to decrease HIV incidence and improve health outcomes. Little is known about the specific resources required to implement UTT in correctional facilities for incarcerated people. The primary aim of this study was to describe the resources used to implement UTT and to provide detailed costing to inform UTT scale-up in similar settings.
The costing study was a cross-sectional descriptive study conducted in three correctional complexes, Johannesburg Correctional Facility in Johannesburg (>4000 inmates) South Africa, and Brandvlei (~3000 inmates), South Africa and Lusaka Central (~1400 inmates), Zambia. Costing was determined through a survey conducted between September and December 2017 that identified materials and labour used for three separate components of UTT: HIV testing services (HTS), ART initiation, and ART maintenance. Our study participants were staff working in the correctional facilities involved in any activity related to UTT implementation. Unit costs were reported as cost per client served while total costs were reported for all clients seen over a 12-month period.
The cost of HIV testing services (HTS) per client was $ 92.12 at Brandvlei, $ 73.82 at Johannesburg, and $ 65.15 at Lusaka. The largest cost driver for HIV testing at Brandvlei were staff costs at 55.6% of the total cost, while at Johannesburg (56.5%) and Lusaka (86.6%) supplies were the largest contributor. The cost per client initiated on ART was $917 for Brandvlei, $421.8 for Johannesburg, and $252.1 for Lusaka. The activity cost drivers were adherence counselling at Brandvlei (59%), and at Johannesburg and Lusaka it was the actual ART initiation at 75.6% and 75.8%, respectively. The annual unit cost for ART maintenance was $2,640.6 for Brandvlei, $710 for Johannesburg, and $385.5 for Lusaka. The activity cost drivers for all three facilities were side effect monitoring, and initiation of isoniazid preventive treatment (IPT), cotrimoxazole, and fluconazole, with this comprising 44.7% of the total cost at Brandvlei, 88.9% at Johannesburg, and 50.5% at Lusaka.
Given the needs of this population, the opportunity to reach inmates at high risk for HIV, and overall national and global 95-95-95 goals, the UTT policies for incarcerated individuals are of vital importance. Our findings provid |
| doi_str_mv | 10.1371/journal.pone.0272595 |
| format | Article |
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The costing study was a cross-sectional descriptive study conducted in three correctional complexes, Johannesburg Correctional Facility in Johannesburg (>4000 inmates) South Africa, and Brandvlei (~3000 inmates), South Africa and Lusaka Central (~1400 inmates), Zambia. Costing was determined through a survey conducted between September and December 2017 that identified materials and labour used for three separate components of UTT: HIV testing services (HTS), ART initiation, and ART maintenance. Our study participants were staff working in the correctional facilities involved in any activity related to UTT implementation. Unit costs were reported as cost per client served while total costs were reported for all clients seen over a 12-month period.
The cost of HIV testing services (HTS) per client was $ 92.12 at Brandvlei, $ 73.82 at Johannesburg, and $ 65.15 at Lusaka. The largest cost driver for HIV testing at Brandvlei were staff costs at 55.6% of the total cost, while at Johannesburg (56.5%) and Lusaka (86.6%) supplies were the largest contributor. The cost per client initiated on ART was $917 for Brandvlei, $421.8 for Johannesburg, and $252.1 for Lusaka. The activity cost drivers were adherence counselling at Brandvlei (59%), and at Johannesburg and Lusaka it was the actual ART initiation at 75.6% and 75.8%, respectively. The annual unit cost for ART maintenance was $2,640.6 for Brandvlei, $710 for Johannesburg, and $385.5 for Lusaka. The activity cost drivers for all three facilities were side effect monitoring, and initiation of isoniazid preventive treatment (IPT), cotrimoxazole, and fluconazole, with this comprising 44.7% of the total cost at Brandvlei, 88.9% at Johannesburg, and 50.5% at Lusaka.
Given the needs of this population, the opportunity to reach inmates at high risk for HIV, and overall national and global 95-95-95 goals, the UTT policies for incarcerated individuals are of vital importance. Our findings provide comparator costing data and highlight key drivers of UTT cost by facility.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0272595</identifier><identifier>PMID: 36006967</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; AIDS ; Anti-HIV Agents - therapeutic use ; Antifungal agents ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Biology and Life Sciences ; CD4 antigen ; Correctional Facilities ; Correctional institutions ; Costs ; Cotrimoxazole ; Counseling ; Cross-Sectional Studies ; Demographic aspects ; Engineering and Technology ; Fluconazole ; Health aspects ; Health risks ; Health services ; HIV ; HIV Infections - diagnosis ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV testing ; Human immunodeficiency virus ; Humans ; Imprisonment ; Infrastructure ; Isoniazid ; Laboratories ; Maintenance ; Management ; Medical tests ; Medicine and Health Sciences ; Nurses ; People and places ; Phlebotomy ; Physicians ; Prisoners ; Prisons ; Safety and security measures ; South Africa - epidemiology ; Teachers ; Wages & salaries ; Zambia - epidemiology</subject><ispartof>PloS one, 2022-08, Vol.17 (8), p.e0272595</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Mukora et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Mukora et al 2022 Mukora et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-fe4e02a4f2b0475159af6d7be221740de1db127acbf3e78cec431218d58b478c3</citedby><cites>FETCH-LOGICAL-c692t-fe4e02a4f2b0475159af6d7be221740de1db127acbf3e78cec431218d58b478c3</cites><orcidid>0000-0002-3629-3867 ; 0000-0003-4304-1729 ; 0000-0002-0083-8319</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9409581/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9409581/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36006967$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mukora, Rachel</creatorcontrib><creatorcontrib>Smith, Helene J</creatorcontrib><creatorcontrib>Herce, Michael E</creatorcontrib><creatorcontrib>Chimoyi, Lucy</creatorcontrib><creatorcontrib>Hausler, Harry</creatorcontrib><creatorcontrib>Fielding, Katherine L</creatorcontrib><creatorcontrib>Charalambous, Salome</creatorcontrib><creatorcontrib>Hoffmann, Christopher J</creatorcontrib><title>Costs of implementing universal test and treat in three correctional facilities in South Africa and Zambia</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Universal test and treat (UTT) is a population-based strategy that aims to ensure widespread HIV testing and rapid antiretroviral therapy (ART) for all who have tested positive regardless of CD4 count to decrease HIV incidence and improve health outcomes. Little is known about the specific resources required to implement UTT in correctional facilities for incarcerated people. The primary aim of this study was to describe the resources used to implement UTT and to provide detailed costing to inform UTT scale-up in similar settings.
The costing study was a cross-sectional descriptive study conducted in three correctional complexes, Johannesburg Correctional Facility in Johannesburg (>4000 inmates) South Africa, and Brandvlei (~3000 inmates), South Africa and Lusaka Central (~1400 inmates), Zambia. Costing was determined through a survey conducted between September and December 2017 that identified materials and labour used for three separate components of UTT: HIV testing services (HTS), ART initiation, and ART maintenance. Our study participants were staff working in the correctional facilities involved in any activity related to UTT implementation. Unit costs were reported as cost per client served while total costs were reported for all clients seen over a 12-month period.
The cost of HIV testing services (HTS) per client was $ 92.12 at Brandvlei, $ 73.82 at Johannesburg, and $ 65.15 at Lusaka. The largest cost driver for HIV testing at Brandvlei were staff costs at 55.6% of the total cost, while at Johannesburg (56.5%) and Lusaka (86.6%) supplies were the largest contributor. The cost per client initiated on ART was $917 for Brandvlei, $421.8 for Johannesburg, and $252.1 for Lusaka. The activity cost drivers were adherence counselling at Brandvlei (59%), and at Johannesburg and Lusaka it was the actual ART initiation at 75.6% and 75.8%, respectively. The annual unit cost for ART maintenance was $2,640.6 for Brandvlei, $710 for Johannesburg, and $385.5 for Lusaka. The activity cost drivers for all three facilities were side effect monitoring, and initiation of isoniazid preventive treatment (IPT), cotrimoxazole, and fluconazole, with this comprising 44.7% of the total cost at Brandvlei, 88.9% at Johannesburg, and 50.5% at Lusaka.
Given the needs of this population, the opportunity to reach inmates at high risk for HIV, and overall national and global 95-95-95 goals, the UTT policies for incarcerated individuals are of vital importance. Our findings provide comparator costing data and highlight key drivers of UTT cost by facility.</description><subject>Acquired immune deficiency syndrome</subject><subject>AIDS</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antifungal agents</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>CD4 antigen</subject><subject>Correctional Facilities</subject><subject>Correctional institutions</subject><subject>Costs</subject><subject>Cotrimoxazole</subject><subject>Counseling</subject><subject>Cross-Sectional Studies</subject><subject>Demographic aspects</subject><subject>Engineering and Technology</subject><subject>Fluconazole</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>Health services</subject><subject>HIV</subject><subject>HIV Infections - diagnosis</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV testing</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Imprisonment</subject><subject>Infrastructure</subject><subject>Isoniazid</subject><subject>Laboratories</subject><subject>Maintenance</subject><subject>Management</subject><subject>Medical tests</subject><subject>Medicine and Health Sciences</subject><subject>Nurses</subject><subject>People and places</subject><subject>Phlebotomy</subject><subject>Physicians</subject><subject>Prisoners</subject><subject>Prisons</subject><subject>Safety and security measures</subject><subject>South Africa - epidemiology</subject><subject>Teachers</subject><subject>Wages & salaries</subject><subject>Zambia - epidemiology</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk1-L1DAUxYso7rr6DUQDgujDjEmaJu2LMAz-GVhYcNUHX0Ka3s5kSJvZJF3025vudJet7IP0oW3yO-cmJ7lZ9pLgJckF-bB3g--VXR5cD0tMBS2q4lF2SqqcLjjF-eN73yfZsxD2GBd5yfnT7CTnGPOKi9Nsv3YhBuRaZLqDhQ76aPotGnpzDT4oiyKEiFTfoOhBRWR6FHceAGnnPehoXFoDapU21kQDYQQu3RB3aNV6o9WN9JfqaqOeZ09aZQO8mN5n2Y_Pn76vvy7OL75s1qvzheYVjYsWGGCqWEtrzERBikq1vBE1UEoEww2QpiZUKF23OYhSg2Y5oaRsirJm6T8_y14ffQ_WBTnFFCQVmAtMMS8SsTkSjVN7efCmU_6PdMrImwHnt1L5aLQFyRiuCCEqrwhlGquKs6KhNWOpHAZNktfHqdpQd9DoFKBXdmY6n-nNTm7dtaySc1GOBu8mA--uhpS27EzQYK3qwQ3TuikVgif0zT_ow7ubqK1KGzB961JdPZrKlSCsKmkhykQtH6DS00BndLpTrUnjM8H7mSAxEX7HrRpCkJvLb__PXvycs2_vsTtQNu6Cs8N4tcIcZEdQexeCh_YuZILl2BK3acixJeTUEkn26v4B3YlueyD_Cxr9Bl0</recordid><startdate>20220825</startdate><enddate>20220825</enddate><creator>Mukora, Rachel</creator><creator>Smith, Helene J</creator><creator>Herce, Michael E</creator><creator>Chimoyi, Lucy</creator><creator>Hausler, Harry</creator><creator>Fielding, Katherine L</creator><creator>Charalambous, Salome</creator><creator>Hoffmann, Christopher J</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-3629-3867</orcidid><orcidid>https://orcid.org/0000-0003-4304-1729</orcidid><orcidid>https://orcid.org/0000-0002-0083-8319</orcidid></search><sort><creationdate>20220825</creationdate><title>Costs of implementing universal test and treat in three correctional facilities in South Africa and Zambia</title><author>Mukora, Rachel ; Smith, Helene J ; Herce, Michael E ; Chimoyi, Lucy ; Hausler, Harry ; Fielding, Katherine L ; Charalambous, Salome ; Hoffmann, Christopher J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-fe4e02a4f2b0475159af6d7be221740de1db127acbf3e78cec431218d58b478c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>AIDS</topic><topic>Anti-HIV Agents - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mukora, Rachel</au><au>Smith, Helene J</au><au>Herce, Michael E</au><au>Chimoyi, Lucy</au><au>Hausler, Harry</au><au>Fielding, Katherine L</au><au>Charalambous, Salome</au><au>Hoffmann, Christopher J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Costs of implementing universal test and treat in three correctional facilities in South Africa and Zambia</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2022-08-25</date><risdate>2022</risdate><volume>17</volume><issue>8</issue><spage>e0272595</spage><pages>e0272595-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Universal test and treat (UTT) is a population-based strategy that aims to ensure widespread HIV testing and rapid antiretroviral therapy (ART) for all who have tested positive regardless of CD4 count to decrease HIV incidence and improve health outcomes. Little is known about the specific resources required to implement UTT in correctional facilities for incarcerated people. The primary aim of this study was to describe the resources used to implement UTT and to provide detailed costing to inform UTT scale-up in similar settings.
The costing study was a cross-sectional descriptive study conducted in three correctional complexes, Johannesburg Correctional Facility in Johannesburg (>4000 inmates) South Africa, and Brandvlei (~3000 inmates), South Africa and Lusaka Central (~1400 inmates), Zambia. Costing was determined through a survey conducted between September and December 2017 that identified materials and labour used for three separate components of UTT: HIV testing services (HTS), ART initiation, and ART maintenance. Our study participants were staff working in the correctional facilities involved in any activity related to UTT implementation. Unit costs were reported as cost per client served while total costs were reported for all clients seen over a 12-month period.
The cost of HIV testing services (HTS) per client was $ 92.12 at Brandvlei, $ 73.82 at Johannesburg, and $ 65.15 at Lusaka. The largest cost driver for HIV testing at Brandvlei were staff costs at 55.6% of the total cost, while at Johannesburg (56.5%) and Lusaka (86.6%) supplies were the largest contributor. The cost per client initiated on ART was $917 for Brandvlei, $421.8 for Johannesburg, and $252.1 for Lusaka. The activity cost drivers were adherence counselling at Brandvlei (59%), and at Johannesburg and Lusaka it was the actual ART initiation at 75.6% and 75.8%, respectively. The annual unit cost for ART maintenance was $2,640.6 for Brandvlei, $710 for Johannesburg, and $385.5 for Lusaka. The activity cost drivers for all three facilities were side effect monitoring, and initiation of isoniazid preventive treatment (IPT), cotrimoxazole, and fluconazole, with this comprising 44.7% of the total cost at Brandvlei, 88.9% at Johannesburg, and 50.5% at Lusaka.
Given the needs of this population, the opportunity to reach inmates at high risk for HIV, and overall national and global 95-95-95 goals, the UTT policies for incarcerated individuals are of vital importance. Our findings provide comparator costing data and highlight key drivers of UTT cost by facility.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>36006967</pmid><doi>10.1371/journal.pone.0272595</doi><tpages>e0272595</tpages><orcidid>https://orcid.org/0000-0002-3629-3867</orcidid><orcidid>https://orcid.org/0000-0003-4304-1729</orcidid><orcidid>https://orcid.org/0000-0002-0083-8319</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2022-08, Vol.17 (8), p.e0272595 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2706702065 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Acquired immune deficiency syndrome AIDS Anti-HIV Agents - therapeutic use Antifungal agents Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences CD4 antigen Correctional Facilities Correctional institutions Costs Cotrimoxazole Counseling Cross-Sectional Studies Demographic aspects Engineering and Technology Fluconazole Health aspects Health risks Health services HIV HIV Infections - diagnosis HIV Infections - drug therapy HIV Infections - epidemiology HIV testing Human immunodeficiency virus Humans Imprisonment Infrastructure Isoniazid Laboratories Maintenance Management Medical tests Medicine and Health Sciences Nurses People and places Phlebotomy Physicians Prisoners Prisons Safety and security measures South Africa - epidemiology Teachers Wages & salaries Zambia - epidemiology |
| title | Costs of implementing universal test and treat in three correctional facilities in South Africa and Zambia |
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