Free HIV Tests Bring Dramatic Results in Tanzania
Friday, February 17, 2006
Eliminating even modest fees for HIV testing can greatly increase the number of those tested in Tanzania and thereby enhance Aids-prevention efforts, US researchers have said.
In a two-week pilot programme, the daily average of people tested for HIV at a clinic in Moshi jumped from four to 15 when the standard test fee of Tsh1,000 ($0.95) was waived, according to a study by Duke University Medical Centre.
“It’s amazing to me that the numbers are so high,” said Dr John Crump, a Duke professor of medicine who works full-time at the Kilimanjaro Christian Medical Centre. “The demand is there. People want to know if they are infected. One reason is because there is more access now to antiretroviral therapy.”
When the fees were reinstated, the numbers being tested dropped to 7 per day.
“I think there is an important policy message here,” said Dr Nathan Thielman, also a professor at Duke University Medical Centre in North Carolina.
“Providing free HIV tests increases the number of clients presenting themselves for evaluation, and makes HIV prevention more cost-effective. We changed our practice because of these results.”
After evaluating the results of the 2003 pilot programme, the Duke team obtained additional funding that enabled the free testing to continue in partnership with Kiwakkuki (a Swahili acronym for Women Against Aids in Kilimanjaro). More than 4,000 people have subsequently been tested at the Moshi clinic.
In addition to making more Tanzanians aware of their HIV status, free testing produces economies of scale that help lower the per-patient cost of prevention and testing programmes, the researchers point out.
When only four people per day were tested at the clinic, it cost $170 to avert a single HIV infection, the study shows. But when the testing rate jumped to 15 people per day, the price of preventing an HIV infection dropped to $92. Counselling is provided as part of the testing process.
Research has shown that HIV testing and counselling reduces high-risk sexual behaviour and prevents HIV transmission, Dr Thielman said. Testing also gives people access to services such as antiretroviral therapy, treatment for sexually-transmitted diseases and prevention of mother-to-child HIV transmission.
Dr Thielman acknowledges that some clinics with limited resources may find it difficult to eliminate testing fees. “But if the goal is to prevent HIV infection, free testing and counselling provides outstanding bang for your buck,” he said.
The initiative may be especially beneficial to Moshi residents because about 16.7 per cent of those tested through the Kiwakkuki programme have been found to be HIV-positive. That is almost twice the national infection rate for Tanzania of 8.8 per cent.
The free tests were promoted locally through a modest advertising campaign. But once the free trials began, the Kiwakkuki Aids Information Centre was deluged with clients. The results of the Duke University study were published in the January 2006 edition of the American Journal of Public Health.