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

• Published in: AIDS (London) Vol. 30; no. 16; pp. 2495 - 2504
• Main Authors: Bautista-Arredondo, Sergio, Sosa-Rubí, Sandra G, Opuni, Marjorie, Contreras-Loya, David, Kwan, Ada, Chaumont, Claire, Chompolola, Abson, Condo, Jeanine, Galárraga, Omar, Martinson, Neil, Masiye, Felix, Nsanzimana, Sabin, Ochoa-Moreno, Ivan, Wamai, Richard, Wang’ombe, Joseph
• Format: Journal Article
• Language: English
• Published: England Copyright Wolters Kluwer Health, Inc 23.10.2016; Lippincott Williams & Wilkins
• Subjects: Africa; AIDS/HIV; Counseling - economics; Diagnostic Tests, Routine - economics; Epidemiology and Social; Female; Health Care Costs; HIV Infections - diagnosis; HIV Infections - economics; HIV Infections - prevention & control; Humans; Infectious Disease Transmission, Vertical - economics; Infectious Disease Transmission, Vertical - prevention & control; Lentivirus; Male; Retrospective Studies; Retroviridae; South Africa; USA; Zambia; Kenya; Rwanda
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0000000000001208

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.