Charles Hongoro

A Cost-Effectiveness Analysis of a Home-Based HIV Counselling and Testing Intervention versus the Standard (Facility Based) HIV Testing Strategy in Rural South Africa.

Introduction There is growing evidence concerning the acceptability and feasibility of home-based HIV testing. However, less is known about the cost-effectiveness of the approach yet it is a critical component to guide decisions about scaling up access to HIV testing. This study examined the cost-effectiveness of a home-based HIV testing intervention in rural South Africa. Methods Two alternatives: clinic and home-based HIV counselling and testing were compared. Costs were analysed from a provider’s perspective for the period of January to December 2010. The outcome, HIV counselling and testing (HCT) uptake was obtained from the Good Start home-based HIV counselling and testing (HBHCT) cluster randomised control trial undertaken in KwaZulu-Natal province. Cost-effectiveness was estimated for a target population of 22,099 versus 23,864 people for intervention and control communities respectively. Average costs were calculated as the cost per client tested, while cost-effectiveness was calculated as the cost per additional client tested through HBHCT. Results Based on effectiveness of 37% in the intervention (HBHCT) arm compared to 16% in control arm, home based testing costs US

A Cost Analysis of a Hospital-Based Palliative Care Outreach Program: Implications for Expanding Public Sector Palliative Care in South Africa

29 compared to US

Changing the policy for intermittent preventive treatment with sulfadoxine–pyrimethamine during pregnancy in Malawi

38 per person for clinic HCT. The incremental cost effectiveness per client tested using HBHCT was

Incentives for lay health workers to improve recruitment, retention in service and performance

19. Conclusions HBHCT was less costly and more effective. Home-based HCT could present a cost-effective alternative for rural ‘hard to reach’ populations depending on affordability by the health system, and should be considered as part of community outreach programs.

Assessment of the multi-sectoral approach to tobacco control policies in South Africa and Togo

CONTEXT Increasing access to palliative care services in low- and middle-income countries is often perceived as unaffordable despite the growing need for such services because of the increasing burden of chronic diseases including HIV and AIDS. OBJECTIVES The aim of the study was to establish the costs and cost drivers for a hospital outreach palliative care service in a low-resource setting, and to elucidate possible consequential quality-of-life improvements and potential cost savings. METHODS The study used a cost accounting procedure to cost the hospital outreach services--using a step-down costing method to measure unit (average) costs. The African Palliative Care Association Palliative Outcome Score (APCA POS) was applied at five intervals to a cohort of 72 consecutive and consenting patients, enrolled in a two-month period. RESULTS The study found that of the 481 and 1902 patients registered for outreach and in-hospital visits, respectively, 4493 outreach hospital visits and 3412 in-hospital visits were done per year. The costs per hospital outreach visit and in-hospital visit were US

The Consideration of Socioeconomic Determinants in Prevention of Traditional Male Circumcision Deaths and Complications

71 and US

Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: evidence from the SANHANES-1, 2011-2012

80, respectively. The cost per outreach visit was 50% less than the average cost of a patient day equivalent for district hospitals of

Facilitating factors and barriers to malaria research utilization for policy development in Malawi

142. Some of the POS of a subsample (n=72) showed statistically significant improvements. CONCLUSION Hospital outreach services have the potential to avert hospital admissions in generally overcrowded services in low-resource settings and may improve the quality of life of patients in their home environments.

Malaria research and its influence on anti-malarial drug policy in Malawi: a case study

BackgroundThe growing resistance of Plasmodium falciparum to sulfadoxine–pyrimethamine (SP) treatment for uncomplicated malaria led to a recommendation by the World Health Organization for the use of artemisinin-based combination therapy. Inevitably, concerns were also raised surrounding the use of SP for intermittent prevention treatment of malaria during pregnancy (IPTp) amidst the lack of alternative drugs. Malawi was the first country to adopt intermittent prevention treatment with SP in 1993, and updated in 2013. This case study examines the policy updating process and the contribution of research and key stakeholders to this process. The findings support the development of a malaria research-to-policy framework in Malawi.MethodsDocuments and evidence published from 1993 to 2012 were systematically reviewed in addition to key informant interviews.ResultsThe online search identified 170 potential publications, of which eight from Malawi met the inclusion criteria. Two published studies from Malawi were instrumental in the WHO policy recommendation which in turn led to the updating of national policies. The updated policy indicates that more than two SP doses, as informed by research, overcome the challenges of the first policy of two SP doses only because of ineffectiveness by P. falciparum resistance and the global lack of replacement drugs to SP for IPTp.ConclusionInternational WHO recommendations facilitated a smooth policy change driven by motivated local leadership with technical and financial support from development partners. Policy development and implementation should include key stakeholders and use local malaria research in a research-to-policy framework.

An assessment of private General Practitioners contracting for public health services delivery in O.R. Tambo District, South Africa

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of financial and non-financial incentives for lay health workers in improving performance, increasing retention, and attracting appropriate LHW candidates.