Costs along the HTC and PMTCT service cascades: findings from Kenya, Rwanda, South Africa, and Zambia

Sergio Bautista-Arredondo, Sandra G. Sosa-Rubí, Marjorie Opuni, David Contreras-Loya, Ada Kwan, Claire Chaumont, Abson Chompolola, Jeanine Condo, Omar Galárraga, Neil Martinson, Felix Masiye, Sabin Nsanzimana, Ivan Ochoa-Moreno, Richard Wamai, Joseph Wang’ombe, on behalf of the ORPHEA study team

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: We estimate facility-level average annual cost per client along the HIV testing and counselling (HTC) and prevention of mother-to-child transmission (PMTCT) service cascades. DESIGN:: Data were collected from 2011–2013 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 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$1,367 (SD US$2,093) 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$2,021 (SD US$3,210) in Rwanda; average cost per client on antiretroviral (ARV) prophylaxis ranged from US$704 (SD US$610) in South Africa to US$2,314 (SD US$3,204) in Rwanda; and average cost per infant on nevirapine (NVP) ranged from US$888 (SD US$884) in South Africa to US$2,359 (SD US$3,257) in Rwanda. CONCLUSIONS:: 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.

Original languageEnglish (US)
JournalAIDS
DOIs
StateAccepted/In press - Jul 29 2016
Externally publishedYes

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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    Bautista-Arredondo, S., Sosa-Rubí, S. G., Opuni, M., Contreras-Loya, D., Kwan, A., Chaumont, C., Chompolola, A., Condo, J., Galárraga, O., Martinson, N., Masiye, F., Nsanzimana, S., Ochoa-Moreno, I., Wamai, R., Wang’ombe, J., & on behalf of the ORPHEA study team (Accepted/In press). Costs along the HTC and PMTCT service cascades: findings from Kenya, Rwanda, South Africa, and Zambia. AIDS. https://doi.org/10.1097/QAD.0000000000001208