Cost-effectiveness of integrated HIV prevention and family planning services for Zambian couples

OBJECTIVE:To present the incremental cost from the payerʼs perspective and effectiveness of couples’ family planning counseling (CFPC) with long-acting reversible contraception (LARC) access integrated with couples’ voluntary HIV counseling and testing (CVCT) in Zambia. This integrated program is ev...

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Published inAIDS (London) Vol. 34; no. 11; pp. 1633 - 1642
Main Authors Wall, Kristin M., Kilembe, William, Inambao, Mubiana, Hoagland, Alexandra, Sharkey, Tyronza, Malama, Kalonde, Vwalika, Bellington, Parker, Rachel, Sarkar, Supriya, Hunter, Ken, Streeb, Gordon, Mazarire, Christine, Tichacek, Amanda, Allen, Susan
Format Journal Article
LanguageEnglish
Published England Wolters Kluwer Health, Inc. All rights reserved 01.09.2020
Copyright Wolters Kluwer Health, Inc
Subjects
Adult
Cost-Benefit Analysis
Counseling
Delivery of Health Care, Integrated - economics
Family Characteristics
Family Planning Services - economics
Female
HIV Infections - prevention & control
Humans
Male
Pregnancy
Program Development
Program Evaluation
Young Adult
Zambia
Zambia
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Summary:OBJECTIVE:To present the incremental cost from the payerʼs perspective and effectiveness of couples’ family planning counseling (CFPC) with long-acting reversible contraception (LARC) access integrated with couples’ voluntary HIV counseling and testing (CVCT) in Zambia. This integrated program is evaluated incremental to existing individual HIV counseling and testing and family planning services. DESIGN:Implementation and modelling. SETTING:Fifty-five government health facilities in Zambia. SUBJECTS:Patients in government health facilities. INTERVENTION:Community health workers and personnel promoted and delivered integrated CVCT+CFPC from March 2013 to September 2015. MAIN OUTCOME MEASURES:We report financial costs of actual expenditures during integrated program implementation and outcomes of CVCT+CFPC uptake and LARC uptake. We model primary outcomes of cost-per-adult HIV infections averted by CVCT, unintended pregnancies averted by LARC, couple-years of protection against unintended pregnancy by LARC, and perinatal HIV infections averted by LARC. Costs and outcomes were discounted at 3% per year. RESULTS:Integrated program costs were $3 582 186 (2015 USD), 82 231 couples received CVCT+CFPC, and 56 409 women received LARC insertions. The program averted an estimated 7165 adult HIV infections at $384 per adult HIV infection averted over a 5-year time horizon. The program also averted 62 265 unintended pregnancies and was cost-saving for measures of cost-per-unintended pregnancy averted, cost-per-couple-year of protection against unintended pregnancy, and cost-per-perinatal HIV infection averted assuming 3 years of LARC use. CONCLUSION:Our intervention was cost-savings for CFPC outcomes and CVCT was effective and affordable in Zambia. Integrated couples-focused HIV and family planning was feasible, affordable, and leveraged HIV and unintended pregnancy prevention.
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Amanda Tichacek contributed to the study conception and design, revised the article critically for important intellectual content, and gave final approval of the version to be published.
Alexandra Hoagland contributed to the conception and design of the study, revised the article critically for important intellectual content, and gave final approval of the version to be published.
Bellington Vwalika contributed to the conception and design of the study, revised the article critically for important intellectual content, and gave final approval of the version to be published.
Kristin M. Wall contributed to the analysis and interpretation of data; drafted the article and revised it critically for important intellectual content; and gave final approval of the version to be published.
Supriya Sarkar contributed to the analysis and interpretation of data; revised the article critically for important intellectual content; and gave final approval of the version to be published.
Tyronza Sharkey contributed to the analysis and interpretation of data; revised the article critically for important intellectual content; and gave final approval of the version to be published.
Christine Mazarire contributed to the analysis and interpretation of data; revised the article critically for important intellectual content; and gave final approval of the version to be published.
William Kilembe contributed to the conception and design of the study, revised the article critically for important intellectual content, and gave final approval of the version to be published.
Mubiana Inambao contributed to the conception and design of the study, revised the article critically for important intellectual content, and gave final approval of the version to be published.
Kalonde Malama contributed to the analysis and interpretation of data; revised the article critically for important intellectual content; and gave final approval of the version to be published.
Rachel Parker contributed to the analysis and interpretation of data; revised the article critically for important intellectual content; and gave final approval of the version to be published.
Ken Hunter contributed to the analysis and interpretation of data; revised the article critically for important intellectual content; and gave final approval of the version to be published.
Susan Allen contributed to the study design and conception, contributed to the analysis and interpretation of data; revised the article critically for important intellectual content, and gave final approval of the version to be published.
Author contributions
ISSN:0269-9370
1473-5571
1473-5571
DOI:10.1097/QAD.0000000000002584