Client satisfaction with service delivery models at the Kenyatta National Hospital Voluntary Counselling and Testing Center (VCT)

Objective: To compare client satisfaction with processes, staff, and physical infrastructure between vertical and integrated service delivery models.Design: Cross-sectional study.Setting: Kenyatta National Hospital (KNH).Participants: Adult participants receiving HIV testing service (HTS) at KNH’s inand out-patient departments.Main outcome measures: Client satisfaction was rated using a 5-point Likert scale. Multivariate analysis was used to compare client satisfaction with processes, staff, and infrastructure in the two models. Results: Enrolled clients enrolled were mainly female (61%), aged 32 years in married monogamous relationships (48%). Clients reported a high level of satisfaction with KNH HIV testing services, with married clients more likely to be satisfied compared to single clients (relative risk, RR: 1.05, 95% CI: 1.00 – 1.10, pvalue: 0.037). Clients were more likely to be satisfied with the processes and physical infrastructure in the vertical model, though waiting times were significantly longer compared to the integrated model.Conclusion: Clients were more satisfied with the vertical HTS model. Service improvements in processes and physical infrastructure in the integrated model will likely improve overall client satisfaction

Assisted partner notification services are cost-effective for decreasing HIV burden in western Kenya

Background: Assisted partner services (aPS) or provider notification for sexual partners of persons diagnosed HIV positive can increase HIV testing and linkage in Sub-Saharan Africa and is a high yield strategy to identify HIV-positive persons. However, its cost-effectiveness is not well evaluated. Methods: Using effectiveness and cost data from an aPS trial in Kenya, we parameterized an individual-based, dynamic HIV transmission model. We estimated costs for both a program scenario and a task-shifting scenario using community health workers to conduct the intervention. We simulated 200 cohorts of 500 000 individuals and projected the health and economic effects of scaling up aPS in a region of western Kenya (formerly Nyanza Province). Findings: Over a 10-year time horizon with universal antiretroviral therapy (ART) initiation, implementing aPS in western Kenya was projected to reach 12.5% of the population and reduce incident HIV infections by 3.7%. In sexual partners receiving aPS, HIV-related deaths were reduced by 13.7%. The incremental cost-effectiveness ratio of aPS was $1094 (US dollars) (90$823–1619) and $833 (90$628–1224) per disability-adjusted life year averted under the program and task-shifting scenario, respectively. The incremental cost-effectiveness ratios for both scenarios fall below Kenya's gross domestic product per capita ($1358) and are therefore considered very cost-effective. Results were robust to varying healthcare costs, linkage to care rates, partner concurrency rates, and ART eligibility thresholds (≤350 cells/μl, ≤500 cells/μl, and universal ART). Interpretation: APS is cost-effective for reducing HIV-related morbidity and mortality in western Kenya and similar settings. Task shifting can increase program affordability