Abstract
BackgroundScaling up services to achieve HIV targets will require that countries optimize the use of available funding. Robust unit cost estimates are essential for the better use of resources, and information on the heterogeneity in the unit cost of delivering HIV services across facilities – both within and across countries – is critical to identifying and addressing inefficiencies. There is limited information on the unit cost of HIV prevention services in sub-Saharan Africa and information on the heterogeneity within and across countries and determinants of this variation is even more scarce. The “Optimizing the Response in Prevention: HIV Efficiency in Africa” (ORPHEA) study aims to add to the empirical body of knowledge on the cost and technical efficiency of HIV prevention services that decision makers can use to inform policy and planning.Methods/DesignORPHEA is a cross-sectional observational study conducted in 304 service delivery sites in Kenya, Rwanda, South Africa, and Zambia to assess the cost, cost structure, cost variability, and the determinants of efficiency for four HIV interventions: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision (VMMC), and HIV prevention for sex workers. ORPHEA collected information at three levels (district, facility, and individual) on inputs to HIV prevention service production and their prices, outputs produced along the cascade of services, facility-level characteristics and contextual factors, district-level factors likely to influence the performance of facilities as well as the demand for HIV prevention services, and information on process quality for HTC, PMTCT, and VMMC services.DiscussionORPHEA is one of the most comprehensive studies on the cost and technical efficiency of HIV prevention interventions to date. The study applied a robust methodological design to collect comparable information to estimate the cost of HTC, PMTCT, VMMC, and sex worker prevention services in Kenya, Rwanda, South Africa, and Zambia, the level of efficiency in the current delivery of these services, and the key determinants of efficiency. The results of the study will be important to decision makers in the study countries as well as those in countries facing similar circumstances and contexts.
Highlights
Scaling up services to achieve HIV targets will require that countries optimize the use of available funding
The study applied a robust methodological design to collect comparable information to estimate the cost of HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision (VMMC), and sex worker prevention services in Kenya, Rwanda, South Africa, and Zambia, the level of efficiency in the current delivery of these services, and the key determinants of efficiency
The ORPHEA study built on past studies while addressing some of the key limitations of previous work and is one of the most comprehensive studies on the cost and technical efficiency of HIV prevention interventions to date
Summary
Scaling up HIV services to achieve national and global targets will require that countries make concerted efforts to optimize the use of available funding. The ORPHEA study built on past studies while addressing some of the key limitations of previous work and is one of the most comprehensive studies on the cost and technical efficiency of HIV prevention interventions to date. It is a multi-country study including four countries that differ in terms of factors likely to impact HIV prevention (e.g., national population HIV prevalence and GDP per capita): Kenya, Rwanda, South Africa, and Zambia. There is limited research on the essential management characteristics associated with well-functioning facilities in LMICs. We made every attempt to be comprehensive given the information available but it is possible that some key aspects of the management of HIV prevention services that are related to efficiency were not captured in our study.
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