Continuous quality improvement (CQI) for HIV testing and counselling services for adolescents (HTC): A cost analysis of implementation

Abstract

The number of adolescents living with HIV is increasing globally. AIDS-related deaths among adolescents have increased while among the other age group people it has decreased. Nevertheless, HIV remains under-diagnosed in this population. We need economic assessment of continuous quality improvement for HIV testing and counselling services that provide cost of scalability and adaptability data for CQI interventions and informs policy makers about the impacts of program dollars spent on such impactful strategies. This would help prioritize methods that ensure high quality preventative services. University of Washington, Seattle, in collaboration with Kenyatta National Hospital, Nairobi, addressed the competency issues of voluntary counselling and testing services provided to adolescents [14 – 15 years] at KNH by implementing CQI. The CQI implementation proved to be beneficial to improve the knowledge of HIV prevention and transmission amongst adolescents, satisfaction among adolescents, intent to retest and health worker satisfaction. For this study, we did a cost analysis of implementation of CQI implementation. We carried out the cost analysis from a payer’s perspective to inform Government of Kenya the costs involved in scaling-up CQI nationally for HTC. We carried out micro-costing analysis utilizing the ingredients approach. We characterized the costs by activities and over time. The CQI intervention needed the expert team, the management team and intervention team including 32 health care professionals for implementation. With investment of $ 6.7 per adolescent and $ 42,509 in total over a period of seven months we were able to improve the knowledge of HIV prevention and transmission amongst adolescents, satisfaction among adolescents, intent to retest and health worker satisfaction. Thus, we conclude that investing in the health workforce training has the potential to improve the efficiency of current HTC services being offered in Kenya.