Abstract
ObjectivesCurrently, HIV testing and counseling (HTC) services in Vietnam are primarily funded by international sources. However, international funders are now planning to withdraw their support and the Government of Vietnam (GVN) is seeking to identify domestic funding and generate client fees to continue services. A clear understanding of the cost to sustain current HTC services is becoming increasingly important to facilitate planning that can lead to making HTC and other HIV services more affordable and sustainable in Vietnam. The objectives of this analysis were to provide a snapshot of current program costs to achieve key program outcomes including 1) testing and identifying PLHIV unaware of their HIV status and 2) successfully enrolling HIV (+) clients in care.MethodsWe reviewed expenditure data reported by 34 HTC sites in nine Vietnamese provinces over a one-year period from October 2012 to September 2013. Data on program outcomes were extracted from the HTC database of 42,390 client records. Analysis was carried out from the service providers’ perspective.ResultsThe mean expenditure for a single client provided HTC services (testing, receiving results and referral for care/treatment) was US $7.6. The unit expenditure per PLHIV identified through these services varied widely from US $22.8 to $741.5 (median: $131.8). Excluding repeat tests, the range for expenditure to newly diagnose a PLHIV was even wider (from US $30.8 to $1483.0). The mean expenditure for one successfully referred HIV client to care services was US $466.6. Personnel costs contributed most to the total cost.ConclusionsOur analysis found a wide range of expenditures by site for achieving the same outcomes. Re-designing systems to provide services at the lowest feasible cost is essential to making HIV services more affordable and treatment for prevention programs feasible in Vietnam. The analysis also found that understanding the determinants and reasons for variance in service costs by site is an important enhancement to the cascade of HIV services framework now adapted for and extensively used in Vietnam for planning and evaluation.
Highlights
Since 1989, when the first report of HIV in Vietnam occurred, the HIV epidemic has been concentrated largely among people who inject drugs (PWID), their sex partners and other key populations at high risk such as female sex workers (FSWs) and men who have sex with men (MSM)
We reviewed expenditure data reported by 34 HIV testing and counseling (HTC) sites in nine Vietnamese provinces over a one-year period from October 2012 to September 2013
Our analysis found a wide range of expenditures by site for achieving the same outcomes
Summary
Since 1989, when the first report of HIV in Vietnam occurred, the HIV epidemic has been concentrated largely among people who inject drugs (PWID), their sex partners and other key populations at high risk such as female sex workers (FSWs) and men who have sex with men (MSM). The current response to the HIV epidemic has been made possible only through substantial external funding and continued dependence on donors, raising major concerns about the sustainability of the service system in Vietnam [4]. HTC services help people learn their HIV status and link those found infected to care and treatment. In Vietnam, international agencies and donors are currently funding HTC and most other services for people living with HIV (PLHIV). Quantifying the current costs of HTC services will help GVN health officials understand, plan and justify an adequate budget, and mobilize investments and resources during this transition period
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