Costs along the service cascades for HIV testing and counselling and prevention of mother-to-child transmission.

Sergio Bautista-Arredondo,Sabin Nsanzimana,Sandra G Sosa-Rubí,Joseph Wang’Ombe,Omar Galárraga,Jeanine Condo,David Contreras-Loya,Ivan Ochoa-Moreno,Marjorie Opuni,Neil Martinson,Abson Chompolola,Felix Masiye,Claire Chaumont,Richard Wamai,Ada Kwan

doi:10.1097/qad.0000000000001208

Abstract

Objective:We estimate facility-level average annual costs per client along the HIV testing and counselling (HTC) and prevention of mother-to-child transmission (PMTCT) service cascades.Design:Data collected covered the period 2011–2012 in 230 HTC and 212 PMTCT facilities in Kenya, Rwanda, South Africa, and Zambia.Methods:Input quantities and unit prices were collected, as were output data. Annual economic costs were estimated from the service providers’ perspective using micro-costing. Average annual costs per client in 2013 United States dollars (US$) were estimated along the service cascades.Results:For HTC, average cost per client tested ranged from US$5 (SD US$7) in Rwanda to US$31 (SD US$24) in South Africa, whereas average cost per client diagnosed as HIV-positive ranged from US$122 (SD US$119) in Zambia to US$1367 (SD US$2093) in Rwanda. For PMTCT, average cost per client tested ranged from US$18 (SD US$20) in Rwanda to US$89 (SD US$56) in South Africa; average cost per client diagnosed as HIV-positive ranged from US$567 (SD US$417) in Zambia to US$2021 (SD US$3210) in Rwanda; average cost per client on antiretroviral prophylaxis ranged from US$704 (SD US$610) in South Africa to US$2314 (SD US$3204) in Rwanda; and average cost per infant on nevirapine ranged from US$888 (SD US$884) in South Africa to US$2359 (SD US$3257) in Rwanda.Conclusion:We found important differences in unit costs along the HTC and PMTCT service cascades within and between countries suggesting that more efficient delivery of these services is possible.

Highlights

After a decade of increases in financing for HIV services in low-income and middle-income countries (LMICs), funding has levelled off [1]
The current cost analysis of HIV testing and counselling (HTC) and prevention of mother-to-child transmission (PMTCT) services in Kenya, Rwanda, South Africa, and Zambia is unique in its focus on estimating costs along the service cascades of these two interventions
We found between-country differences in the first and second steps of the HTC and PMTCT cascades; in general, after adjusting for differences in prices, the average cost per client tested was lower in Rwanda, whereas the average cost per client diagnosed as HIV-positive was higher for both HTC and PMTCT

Summary

Introduction

After a decade of increases in financing for HIV services in low-income and middle-income countries (LMICs), funding has levelled off [1]. With few exceptions [14,15], existing empirical HTC and PMTCT cost data focus on one step of the service cascade – cost per person tested for HTC and cost per woman or per mother–baby pair receiving antiretroviral prophylaxis for PMTCT. These studies do not provide the cost data along service cascades that are critical for identifying and addressing implementation inefficiencies

Methods

Results

Conclusion