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. ? 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

6. 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

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 Some CE results available in July Behavioural survey and modelling complete December 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 costs Economic 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