Evaluation of Mobile Multi-Disease Screening Clinic (Bophelo!)
Namibia is a huge and sparsely populated country where the cost and difficulty of transport—as well as stigma—discourage many residents from determining their HIV status. Under its Bophelo! (“life” in Tswana, one of the 11 official languages in Namibia) program, Pharmaccess Namibia operates two vans which are licensed by the Namibia Ministry of Health and Social Services as screening clinics. By traveling to work sites and remote locations, the Bophelo! program seeks to increase uptake of HIV tests while screening for additional diseases at low incremental cost. The Bophelo! vans test for HIV and eight other conditions and risk factors (abnormal hemoglobin, hypertension, high cholesterol, high blood sugar, Hepatitis B, syphilis, TB, and obesity). Working with Pharmaccess Namibia, the CGHD determined the unit cost for patients screened by the Bophelo! mobile clinics and compared it to the cost per patient screened by New Start fixed Voluntary Testing and Counseling clinics. USAID supported the study and provides funding for the New Start clinics. Pharmaccess partnered with the Namibian Business Coalition on AIDS (NABCOA) and the Namibian Institute of Pathology to develop the Bophelo! program.
Bophelo! funds received from a GFATM grant are supplemented by charges to employers for Bophelo!’s screening services. Working from fixed sites, the USAID-sponsored New Start program provides free voluntary counseling and testing for HIV. Unit costs per patient screened for HIV at Bophelo! in 2009 were 4% more than those at New Start. However, employers paid approximately one third of Bophelo! costs, so the publicly supported costs of the mobile screening program were 35% less than those at New Start. In addition, at a modest incremental cost (14.5%), Bophelo! screened for the additional diseases. While 9% of those tested by Bophelo! were HIV positive, over half of the patients tested showed one or more of the nine conditions or risk factors and were referred for follow up. Uptake of Bophelo! screening at work sites was very high, presumably because of convenience and the reduced stigma associated with multiple disease screening. Compared to New Start, a higher percentage of those tested were male. At remote testing sites, Bophelo! was able to reach many patients who had never tested for HIV before. The analysis showed that the public/private partnership and mobile screening strategy embodied in Bophelo! can be an efficient way to expand screening for HIV and other diseases common in Africa.
This project is one activity under the CGHD’s Child and Family Applied Research project (CFAR).
|Principal Investigator||Rich Feeley|
|Dates of Research||2008–2011|
|Donor/Funder||United States Agency for International Development (USAID)|