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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2004.056796v1 96/1/114    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Thielman, N. M. Articles by Crump, J. A. Search for Related Content PubMed PubMed Citation Articles by Thielman, N. M. Articles by Crump, J. A. Related Collections Global Health Health Care Facilities/Services HIV/AIDS Prevention Public Health Practice Public Health Workers

Nathan M. Thielman, MD, MPH, Helen Y. Chu, MD, Jan Ostermann, PhD, Dafrosa K. Itemba, BA, Anna Mgonja, Sabina Mtweve, MD, MHP, John A. Bartlett, MD, John F. Shao, MD, PhD and John A. Crump, MB, ChB, DTM&H

At the time of the study, Nathan M. Thielman, John A. Bartlett, John A. Crump, and Helen Y. Chu were with the Division of Infectious Diseases and International Health at Duke University Medical Center, Durham, NC. Jan Ostermann is with the Health Inequalities Program, Terry Sanford Institute of Public Policy, Duke University. Dafrosa K. Itemba, Anna Mgonja, and Sabina Mtweve are with KIWAKKUKI (Kikundi cha Wanawake Kilimanjaro Kupambana UKIMWI; Women Against AIDS in Kilimanjaro). John F. Shao is with Tumaini University, Moshi, Tanzania. Sabina Mtweve and John A. Crump are also with Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical College of Tumaini University, Moshi.

Correspondence: Requests for reprints should be sent to John A. Crump, Division of Infectious Diseases and International Health, Duke University Medical Center, Box 3867, Durham, NC 27701 (e-mail: crump017{at}mc.duke.edu).

Objectives. We evaluated the cost-effectiveness of fee-based and free testing strategies at an HIV voluntary counseling and testing (VCT) program integrated into a community-based AIDS service organization in Moshi, Tanzania.

Methods. We waived the usual fee schedule during a 2-week free, advertised VCT campaign; analyzed the number of clients testing per day during prefree, free, and postfree testing periods; and estimated the cost-effectiveness of limited and sustained free testing strategies.

Results. The number of clients testing per day increased from 4.1 during the prefree testing interval to 15.0 during the free testing campaign (P<.0001) and remained significantly increased at 7.1 (P<.0001) after resumption of the standard fees. HIV seroprevalence (16.7%) and risk behaviors were unchanged over these intervals. Modeled over 1 year, the costs per infection averted with the standard fee schedule, with a 2-week free VCT campaign, and with sustained free VCT year-round were $170, $105, and $92, respectively, and the costs per disability-adjusted life year gained were $8.72, $5.40, and $4.72, respectively.

Conclusions. The provision of free VCT enhances both the number of clients testing per day and its cost-effectiveness in resource-limited settings.

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