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

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

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

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

? Improve TB case holding 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

Education for HIV prevention 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

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

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.

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.

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

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

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

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

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

Average costs Economic costs, US $

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