National Evaluation of HIV Service Resource Allocation in Tanzania

Author:

McBain Ryan K.ORCID,Jordan MonicaORCID,Mann CarlynORCID,Ruhago George M.ORCID,Lee Bryant,Forsythe StevenORCID,Stewart Kaylee,Brown Jessica,Nandakumar AllyalaORCID

Abstract

AbstractUsing time-driven activity-based costing (TDABC), we examined resource allocation and costs for HIV services throughout Tanzania at patient and facility levels. This national, cross-sectional analysis of 22 health facilities quantified costs and resources associated with 886 patients receiving care for five HIV services: antiretroviral therapy, prevention of mother-to-child transmission, HIV testing and counseling, voluntary medical male circumcision, and pre-exposure prophylaxis. We also documented total provider-patient interaction time, the cost of services with and without inclusion of consumables, and conducted fixed-effects multivariable regression analyses to examine patient- and facility-level correlates of costs and provider-patient time. Findings showed that resources and costs for HIV care varied significantly throughout Tanzania, including as a function of patient- and facility-level characteristics. While some variation may be preferable (e.g., needier patients received more resources), other areas suggested a lack of equity (e.g., wealthier patients received more provider time) and presented opportunities to optimize care delivery protocols.

Funder

Palladium International

Global Fund to Fight AIDS, Tuberculosis and Malaria

RAND Corporation

Publisher

Springer Science and Business Media LLC

Subject

Infectious Diseases,Public Health, Environmental and Occupational Health,Social Psychology

Reference40 articles.

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2. UNAIDS. Country Factsheets: United Republic of Tanzania 2020: HIV and AIDS estimates. 2022. https://www.unaids.org/en/regionscountries/countries/unitedrepublicoftanzania. Accessed 16 Mar 2022.

3. UNICEF. HIV and AIDS Budget Brief 2020—Mainland Tanzania. https://www.unicef.org/esa/media/8426/file/UNICEF-Tanzania-Mainland-2020-HIV-Budget-Brief-revised.pdf. Accessed 9 Mar 2022.

4. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global AIDS Report. 2020: Seizing the Moment: Tackling entrenched inequalities to end epidemics. 2020. https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf. Accessed 15 Apr 2022.

5. Centers for Disease Control and Prevention (CDC). Global Health - Tanzania. 2022. https://www.cdc.gov/globalhealth/countries/tanzania/default.htm. Accessed 9 Mar 2022.

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