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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Program spending to increase adherence: South African cervical cancer screening
PLoS ONE, Volume 4, No. 5, Article e5691, Year 2009
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Description
Background: Adherence is crucial for public health program effectiveness, though the benefits of increasing adherence must ultimately be weighed against the associated costs. We sought to determine the relationship between investment in community health worker (CHW) home visits and increased attendance at cervical cancer screening appointments in Cape Town, South Africa. Methodology/Principal Findings: We conducted an observational study of 5,258 CHW home visits made in 2003-4 as part of a community-based screening program. We estimated the functional relationship between spending on these visits and increased appointment attendance (adherence). Increased adherence was noted after each subsequent CHW visit. The costs of making the CHW visits was based on resource use including both personnel time and vehicle-related expenses valued in 2004 Rand. The CHW program cost R194,018, with 1,576 additional appointments attended. Adherence increased from 74% to 90%; 55% to 87%; 48% to 77%; and 56% to 80% for 6-, 12-, 24-, and 36-month appointments. Average per-woman costs increased by R14-R47. The majority of this increase occurred with the first 2 CHW visits (90%, 83%, 74%, and 77%; additional cost: R12-R26). Conclusions/Significance: We found that study data can be used for program planning, identifying spending levels that achieve adherence targets given budgetary constraints. The results, derived from a single disease program, are retrospective, and should be prospectively replicated. © 2009 Goldhaber-Fiebert et al.
Authors & Co-Authors
Goldhaber-Fiebert, Jeremy D.
United States, Boston
Harvard T.h. Chan School of Public Health
United States, Stanford
Stanford University School of Medicine
Denny, Lynette A.
South Africa, Cape Town
University of Cape Town
de Souza, Michelle
South Africa, Cape Town
Khayelitsha Cervical Cancer Screening Project Kccsp
Kuhn, Louise
United States, New York
Gertrude H. Sergievsky Center
Goldie, Sue J.
United States, Boston
Harvard T.h. Chan School of Public Health
Statistics
Citations: 30
Authors: 5
Affiliations: 5
Identifiers
Doi:
10.1371/journal.pone.0005691
e-ISSN:
19326203
Research Areas
Cancer
Study Design
Cohort Study
Study Locations
South Africa
Participants Gender
Female