This study aims to evaluate the cost, effectiveness and feasibility of setting up routine offers of HIV counseling and testing in community hospitals. Three methodologies were used : the first was Cluster Randomized Controlled Trials in 16 community hospitals, the second was a cost-effectiveness analysis and the third was qualitative research to investigate the feasibility and acceptance of the program if it is implemented. The preliminary results showed that the acceptance rate for HIV counseling and testing in experimental hospitals in the intervention period was 5.16% compared with 0.41% in control hospitals. The number of new HIV cases detected increased from 9 persons in control hospitals to 21 persons in experimental hospitals. The effectiveness of the program after being adjusted for the prevalence of HIV infection, and the location of the hospital, was 60.79 (IRR =60.79, 95%CI =28.74, 128.56) and 3.77 (IRR =3.77, 95%CI=1.01, 12.91) for acceptance rate and HIV detection rate respectively. Cost-effectiveness analysis showed that routine offers of HIV counseling and testing had a cost-effectiveness ratio of 67,748.32 baht/ new case of HIV detected and 465,952.32 baht/ new case of HIV averted. Qualitative research investigating the feasibility of the program will be done next time.
WHO and UNAIDS advocated healthcare providers to consider provider-initiated HIV counseling and testing for clients attending healthcare facilities. However, there is a lack of evidence, concerning the effectiveness of such interventions in Thailand and other settings with large outbreaks of the HIV epidemic, needed to support policy decisions. A clusterrandomization trial with pre-post test design was conducted to assess the effectiveness of provider-initiated voluntary HIV counseling and testing compared with the current practice in which HIV testing is provided upon the client’s request. Sixteen district hospitals (clusters) with high- and low-HIV prevalence were randomly assigned to either receiving the new intervention or the current practice with a 1:1 allocation ratio. Patients aged between 13-64 years, receiving ambulatory care in the participating hospitals, were eligible. The main outcome measures were the acceptance rate of HIV testing and the HIV detection rate. During the first 8-week baseline period, there was no significant difference between the control and experimental clusters on the acceptance rate and HIV detection. However, after the 8-week intervention period, the acceptance rate and HIV detection rate in the experimental clusters was significantly higher than those of the control clusters. The results from the generalised estimating equations and multilevel modeling also confirmed the findings. Economic appraisal alongside this study suggested that the intervention is very costeffective under the Thai health care setting.