The economics of HIV testing in Africa

Abstract

This thesis examines the problem of resource allocation in Africa to combat the HIV/AIDS epidemic. It focuses on the use of one specific technology, the anti-HIV antibody test. After describing the characteristics of the epidemic, the special problems that accompany the allocation of health resources in Africa are explored. A short description of the biological and technical aspects of HIV testing is followed by three case studies which examine different uses of the technology. (1) A model of the use of HIV testing to screen blood donors is demonstrated in several hypothetical situations to evaluate under which circumstances HIV screening is cost-effective and which is the most cost-effective of a number of testing systems. (2) Use of the HIV test is considered from a cost-effectiveness perspective for the purpose of helping to confirm the diagnosis of HIV-related disease. Possible benefits of testing (including more rapid initiation of appropriate treatment, avoidance of the cost and iatrogenic complications of inappropriate treatment, and more efficient rationing of health care resources) are compared to possible costs (including monetary costs, emotional costs, and costs associated with false test results). A detailed protocol is presented of a prospective study to evaluate the appropriate use of the HIV test in the inpatient hospital setting. (3) Serologic surveys, including procurement of samples and testing for HIV, comprise the bulk of any program to monitor and characterize the epidemiology of the HIV/AIDS epidemic.

(cont.) The descriptive data thus gathered can then be used to more effectively target interventions to prevent further HIV spread and alleviate the impact of HIV/AIDS. Two models are presented which can be used to optimize the cost-efficiency of serologic surveys by improving the selection of sample size and testing method. The conclusions draw upon the findings of the three case studies. They place the fight against AIDS in its social and economic context in Africa; outline the general rules that govern the use of HIV testing technology; and underscore the need for cost-effectiveness assessments to improve the efficiency of resource allocation by national AIDS programs.