Abstrak: 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.

Abstrak: Latar Belakang: Prevalensi HIV/AIDS di Indonesia mengalami peningkatan signifikan setiap tahunnya, termasuk di Bali dan Gianyar, namun pemanfaatan VCT masih rendah, di Gianyar hanya 28,4%. Rendahnya pemanfaatan VCT berhubungan dengan faktor-faktor seperti umur, status perkawinan, pendidikan, pekerjaan, pengetahuan HIV-AIDS dan VCT, persepsi pelayanan kesehatan, stigma, diskriminatif, dukungan pasangan, keluarga dan teman, dukungan petugas kesehatan, dukungan LSM, keterampilan petugas dan akses ke pelayanan kesehatan. Tujuan: Untuk mengetahui faktor-faktor yang berhubungan dengan pemanfaatan klinik VCT HIV-AIDS di RSUD Sanjiwani, Gianyar tahun 2017. Metode: Penelitian ini adalah studi potong lintang, metode kuantitatif. Populasi penelitian adalah seluruh responden yang berkunjung ke klinik VCT RSUD Sanjiwani. Sampel adalah seluruh responden yang berkunjung ke klinik VCT bulan Oktober sampai November 2017 yang memenuhi kriteria inklusi, bersedia ikut dalam penelitian dan menandatangani inform consent dan sampel diambil secara konsekutif. Pengumpulan data primer dengan wawancara menggunakan kuesioner, data sekunder diambil dari register kunjungan klinik VCT. Analisis data menggunakan spss dan penyajian hasil dalam bentuk tabel. Hasil: Terdapat 70 responden yang ikut dalam penelitian ini, didapatkan hubungan bermakna antara umur, pengetahuan VCT, sikap keluarga, sikap pasangan, dukungan LSM, akses pelayanan kesehatan dengan persepsi individu. Adanya hubungan bermakna antara umur, pendidikan, pengetahuan HIV-AIDS, pengetahuan VCT, persepsi pelayanan kesehatan, stigma dan diskriminasi, sikap keluarga, sikap pasangan, sikap petugas kesehatan, dukungan LSM, keterampilan petugas kesehatan dan persepsi individu terhadap pemanfaatan VCT. Persepsi individu, stigma dan diskriminasi merupakan tiga faktor dominan berhubungan dengan pemanfaatan VCT. Kesimpulan: terdapat berbagai faktor yang berhubungan dengan pemanfaatan VCT, pada penelitian ini persepsi individu, stigma, umur dan diskriminasi behubungan dominan terhadap pemanfaatan VCT. Adanya stigma dan diskriminatif yang tinggi, serta rendahnya persepsi undividu, perlu dilakukan intervensi untuk mengeliminasi hal tersebut. Kata kunci: VCT, HIV-AIDS dan Pemanfaatan VCT. ABSTRACT Background: Prevalence of HIV / AIDS in Indonesia has increased significantly every year, including in Bali and Gianyar, but VCT utilization is verry low, in Gianyar just only 28.4%. The low utilization of VCT relates to factors such as age, marital status, education, employment, HIV-AIDS knowledge and VCT, health service perceptions, stigma, discrimination, partner support, family and friends, health care support, NGO support, access to health services. Aims: To know the factors related to the utilization of VCT HIV-AIDS clinic in RSUD Sanjiwani, Gianyar 2017. Methods: This research is cross sectional study, quantitative method. The study population was all respondents who visited the VCT clinic RSUD Sanjiwani. Samples were all respondents who visited VCT clinics from October to November 2017 who met the inclusion criteria, were willing to take part in the research and sign the informed consent and the sample was taken consecutively. Primary data collection by interview using questionnaires, secondary data is taken from the VCT clinic visit register. Data analysis using spss and presentation of results in tabular form. Results: There were 70 respondents who participated in this study, found significant relationship between age, knowledge of VCT, family attitudes, couples attitude, NGO support, access to health services with individual perceptions. There is a significant relationship between age, education, HIV-AIDS knowledge, VCT knowledge, health service perceptions, stigma and discrimination, family attitudes, partner attitudes, health officer attitudes, NGO support, health officer skills and individual perceptions of VCT utilization. Individual perceptions, stigma and discrimination are the three dominant factors associated with VCT utilization. Conclusions: there are various factors related to the utilization of VCT, in this study individual perceptions, stigma, age and discrimination are dominant relation to the utilization of VCT. High stigma and discrimination and low individual perceptions, need to be intervened to eliminate it. Keywords: VCT, HIV-AIDS, and VCT utilization.

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