TY - JOUR
T1 - Assessing cost and technical efficiency of HIV prevention interventions in sub-Saharan Africa
T2 - The ORPHEA study design and methods
AU - Bautista-Arredondo, Sergio
AU - Sosa-Rubí, Sandra G.
AU - Opuni, Marjorie
AU - Kwan, Ada
AU - Chaumont, Claire
AU - Coetzee, Jenny
AU - Condo, Jeanine
AU - Dzekedzeke, Kumbutso
AU - Galárraga, Omar
AU - Martinson, Neil
AU - Masiye, Felix
AU - Nsanzimana, Sabin
AU - Wamai, Richard
AU - Wang'ombe, Joseph
AU - Alonso, Amilcar Azamar
AU - Gonzalez, Roberto Bahena
AU - Loya, David Contreras
AU - Moreno, Ivan Ochoa
AU - Buzdugan, Raluca
AU - Mugo, Mercy
AU - Nyakundi, Hellen
AU - Ayingoma, Jean Pierre
AU - Mugwaneza, Placidie
AU - Remera, Eric
AU - Kamanzi, Collins
AU - Mulindahabi, Nathalie
AU - Musabyimana, Angele
AU - Musange, Sabine
AU - Dire, Charity
AU - Lebina, Limakatso
AU - Sekhukuni, Sabelo
AU - Chauwa, Sydney
AU - Chitah, Bona
AU - Chompolola, Abson
AU - ORPHEA study team
PY - 2014
Y1 - 2014
N2 - Background: Scaling 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/Design: ORPHEA 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. Discussion: ORPHEA 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.
AB - Background: Scaling 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/Design: ORPHEA 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. Discussion: ORPHEA 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.
KW - AIDS
KW - Cost
KW - Economic evaluation
KW - HIV
KW - Male circumcision
KW - PMTCT
KW - Prevention
KW - Sex workers
KW - Technical efficiency
KW - Testing
UR - http://www.scopus.com/inward/record.url?scp=84988660477&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84988660477&partnerID=8YFLogxK
U2 - 10.1186/s12913-014-0599-9
DO - 10.1186/s12913-014-0599-9
M3 - Article
C2 - 25927555
AN - SCOPUS:84988660477
SN - 1472-6963
VL - 14
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 599
ER -