The cost of community outreach HIV interventions: a case study in Thailand

Kyaw Min Soe,Katharina Hauck,Sukhum Jiamton,Sukhontha Kongsin

doi:10.1186/s12889-021-12416-x

Kyaw Min Soe, Katharina Hauck + Show 2 more

Open Access

https://doi.org/10.1186/s12889-021-12416-x

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Abstract

BackgroundThere was an estimated 440,000 people living with HIV in Thailand in 2018. New cases are declining rapidly thanks to successful prevention programs and scaling up of anti-retroviral therapy (ART). Thailand aims to achieve its commitment to end the HIV epidemic by 2030 and implemented a cascade of HIV interventions through the Reach-Recruit-Test-Treat-Retain (RRTTR) program.MethodsThis study focused on community outreach HIV interventions implemented by Non-Governmental Organizations (NGOs) under the RRTTR program in 27 provinces. We calculated unit cost per person reached for HIV interventions targeted at key-affected populations (KAPs) including men who have sex with men/ transgender (MSM/TG), male sex workers (MSW), female sex workers (FSW), people who inject drugs (PWID) and migrants (MW). We studied program key outputs, costs, and unit costs in variations across different HIV interventions and geographic locations in Thailand. We used these estimates to determine costs of HIV interventions and evaluate economies of scale.ResultsThe interventions for migrants in Samut Sakhon was the least costly with a unit cost of 21.6 USD per person to receive services, followed by interventions for migrants in Samut Prakan 23.2 USD per person reached, MSM/TG in Pratum Thani 26.5USD per person reached, MSM/TG in Nonthaburi 26.6 USD per person reached and, MSM/TG in Chon Buri with 26.7 USD per person. The interventions yielded higher efficiency in large metropolitan and surrounding provinces. Harm reduction programs were the costliest compare with other interventions. There was association between unit cost and scale of among interventions indicating the presence of economies scale. Implementing HIV and TB interventions jointly increased efficiency for both cases.ConclusionThis study suggested that unit cost of community outreach HIV and TB interventions led by CSOs will decrease as they are scaled up. Further studies are suggested to follow up with these ongoing interventions for identifying potential contextual factors to improve efficiency of HIV prevention services in Thailand.

Highlights

There was an estimated 440,000 people living with Human immuno-deficiency virus (HIV) in Thailand in 2018
Research setting This study focused on community-based HIV interventions implemented by Non-Governmental Organizations (NGOs) as Implementing agencies (IAs) under RRTTR program in 27 provinces with relatively high prevalence of HIV in Thailand (Fig. 1) [6]
The results show that HIV intervention for migrants in Samut Sakhon province was found to be the least costly with the lowest unit cost of 10.8 USD per person reached, which is followed by intervention for migrants in Samut Prakan at 12.7 USD per person reached, men who have sex with men (MSM)/transgender people (TG) in Chiang Mai (14.8 USD per person reached), men who have sex with men/ transgender (MSM/TG) in Nonthaburi (15 USD) and MSM/TG (15.2 USD) in Pratum Thani (Table 2)

Summary

Introduction

There was an estimated 440,000 people living with HIV in Thailand in 2018. New cases are declining rapidly thanks to successful prevention programs and scaling up of anti-retroviral therapy (ART). Thailand aims to achieve its commitment to end the HIV epidemic by 2030 and implemented a cascade of HIV interventions through the Reach-Recruit-Test-Treat-Retain (RRTTR) program. New cases reported have been rapidly declining thanks to its Domestic resources account for more than 85% of the policy response to HIV and TB in Thailand. In 2015, Thailand launched a series of HIV preventive interventions through the Reach-Recruit-Test-Treat-Retain (RRTTR) program with the support of the Global Fund. Under RRTTR, civil society organizations (CSOs) or non-governmental organizations (NGOs) were contracted as implementing agencies (IAs) for community-based preventive interventions in an active case finding approach to reach out to KAPs, improve uptake of for HIV counselling and testing (HCT) and support effective linkages to treatment initiation and retention through collaboration with government health service providers [5]. RRTTR granted some IAs to provide TB care services for migrant workers in combination with HIV services [6]

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