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Progress of formal evaluation of ProTEST activities

This evaluation aims to learn lessons from ProTEST pilot projects on the delivery of preventive therapy (PT) within the context of VCT, TB screening/active case finding, STI treatment, and HIV care. The evaluation will assess the costs and cost-effectiveness of these initiatives in reducing HIV and TB transmission.

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Progress of formal evaluation of ProTEST activities

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  1. Progress of formal evaluation of ProTEST activities Lilani Kumaranayake, Charlotte Watts, Peter Godfrey-Faussett, LSHTM in collaboration with Country ProTEST teams

  2. Purpose of evaluation • Learning lessons from pilot projects on delivery of preventive therapy (PT) within a broader context of VCT, TB screening/active case finding and STI treatment, and support/care of HIV positive inidividuals • There is little known of costs, cost-effectiveness of such initiatives on reducing transmission of HIV and TB infection

  3. Purpose of evaluation (2) • Each country with ProTEST activities has variation in nature of activities • Little knowledge of how different methods of implementing activities will affect overall cost and cost-effectiveness of ProTEST

  4. Conceptual Approach to evaluation • Impact depends on type of activities • Flow chart on next slide shows conceptual approach behind measurement of impact and cost-effectiveness • Core activities: • VCT + Screening for TB + PT • Other activities • Treatment of STI; clinical care of OI, home-based care

  5. Incentives VCT Screen Active TB Screen and treat STDs Behaviour Change PT Treat Active TB Prevent HIV Prevent HIV Prevent TB ? Improve TB case holding

  6. Incentives VCT Screen for active TB Care support of PWA Screen/ treat STDs ARVs Psycho- social Cotrim HBC Clinics PWA groups Behaviour Change Treat or PT MTCT HAART Reduce stigma Treatment OI Education TB/HIV Education for HIV prevention Prevent HIVrelated illness Prevent HIV infection Prevent HIV infection Prevent HIV infection Prevent TB cases Prevent TB cases Prevent TB cases Prevent TB cases Prevent TB cases

  7. Activities related to evaluation • Cost Analysis (in Zambia, Malawi, South Africa, Uganda) • Behavioural surveys (Zambia, Malawi) • to measure behaviour change associated with VCT • Model development of VCT model • to estimate HIV infections averted from behaviour change information • Economic Analysis • cost-effectiveness, feasibility, sustainability

  8. Time-frame for CE analysis • Malawi • Cost data collection complete, June 2002. Some CE results available in July 2002. Behavioural survey and modelling complete December 2002. Full CE results by March 2003. • Zambia • Some components complete with preliminary CE. • Due to delay in MTCT/PT project , likely that behavioural surveys only complete mid-2003, with CE results about September 2003.

  9. Time-frame for CE analysis • South Africa • Cost data collection and some CE results likely December 2002. • Undertaking own behavioural survey; dependent on external funding. • Uganda • Cost activities not began due to delay of project.

  10. Preliminary Cost Results from ProTEST, Zambia Fern Terris-Prestholt and Lilani Kumaranayake

  11. In collaboration with • Rokaya Ginwalla • Helen Ayles • Ignatius Kayawe • Peter Godfrey-Faussett

  12. Methods • Cost data collection in 2 sites (Chawama with established VCT and Matero, start-up of both VCT and PT) • Retrospective and ingredients-based • Financial costs: actual expenditure on goods and services • Economic costs: include value for resources used even if no financial transactions

  13. Total costs of co-ordination and implemenation • Core Activities: • ProTEST co-ordination • ProTEST clinic • VCT • PT • Outreach • Other Activities • community home-based care • hospice

  14. Total economic costs of co-ordination and implementation, 2001 • Over two sites core activities were US $105,539 • Co-ordination: • US $3556 (5%) in Chawama and $3893 (13%) in Matero • VCT costs: • US $43,719 (58%) in Chawama and US $ 7810 (25%) in Matero • Cost of adding PT to VCT services: • US $ 701 in Chawama (1%)and US $ 967 (3%) in Matero • Clinical care: • 18% of Chawama core costs and 44% of Matero core costs

  15. Average costsEconomic costs, US $

  16. Factors influencing costs • Inclusion/exclusion of start-up costs • advanced stage of HIV+ people meant small numbers eligible for start of PT • gaps in Matero activities • low rates of compliance of PT • Chawama: 19% completing 6 months • Matero: 47% completing 6 months • Despite this, still relative low average costs for these services

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