Cost-effectiveness of free HIV voluntary counseling and testing through a community-based AIDS service organization in northern Tanzania

Objectives. We evaluated the cost-effectiveness of fee-based and free testing strategies at an HIV voluntary counseling and testing (VCT) program integrated into a community-based AIDS service organization in Moshi, Tanzania. Methods. We waived the usual fee schedule during a 2-week free, advertised VCT campaign; analyzed the number of clients testing per day during prefree, free, and postfree testing periods; and estimated the cost-effectiveness of limited and sustained free testing strategies. Results. The number of clients testing per day increased from 4.1 during the prefree testing interval to 15.0 during the free testing campaign (P <.0001) and remained significantly increased at 7.1 (P <.0001) after resumption of the standard fees. HIV seroprevalence (16.7%) and risk behaviors were unchanged over these intervals. Modeled over 1 year, the costs per infection averted with the standard fee schedule, with a 2-week free VCT campaign, and with sustained free VCT year-round were $170, $105, and $92, respectively, and the costs per disability-adjusted life year gained were $8.72, $5.40, and $4.72, respectively. Conclusions. The provision of free VCT enhances both the number of clients testing per day and its cost-effectiveness in resource-limited settings.