Abstract
AbstractBackgroundData remain scarce on the costs of HIV services for key populations (KPs). The objective of this study was to bridge this gap in the literature by estimating the unit costs of HIV services delivered to KPs in the LINKAGES program in Kenya and Malawi. We estimated the mean total unit costs of seven clinical services: post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), HIV testing services (HTS), antiretroviral therapy (ART), sexually transmitted infection (STI) services, sexual and reproductive health (SRH) services, and management of sexual violence (MSV). These costs take into account the costs of non-clinical services delivered alongside clinical services and the pre-service and above-service program management integral to the LINKAGES program.MethodsData were collected at all implementation levels of the LINKAGES program including 30 drop-in-centers (DICs) in Kenya and 15 in Malawi. This study was conducted from the provider’s perspective. We estimated economic costs for FY 2019 and cost estimates include start-up costs. Start-up and capital costs were annualized using a discount rate of 3%. We used a combination of top-down and bottom-up costing approaches. Top-down methods were used to estimate the costs of headquarters, country offices, and implementing partners. Bottom-up micro-costing methods were used to measure the quantities and prices of inputs used to produce services in DICs. Volume-weighted mean unit costs were calculated for each clinical service. Costs are presented in 2019 United States dollars (US$).ResultsThe mean total unit costs per service ranged from US$18 (95% CI: 16, 21) for STI services to US$635 (95% CI: 484, 785) for PrEP in Kenya and from US$41 (95% CI: 37, 44) for STI services to US$1,240 (95% CI 1156, 1324) for MSV in Malawi. Clinical costs accounted for between 21 and 59% of total mean unit costs in Kenya, and between 25 and 38% in Malawi. Indirect costs—including start-up activities, the costs of KP interventions implemented alongside clinical services, and program management and data monitoring—made up the remaining costs incurred.ConclusionsA better understanding of the cost of HIV services is highly relevant for budgeting and planning purposes and for optimizing HIV services. When considering all service delivery costs of a comprehensive HIV service package for KPs, costs of services can be significantly higher than when considering direct clinical service costs alone. These estimates can inform investment cases, strategic plans and other budgeting exercises.
Funder
Bill and Melinda Gates Foundation
Publisher
Springer Science and Business Media LLC
Reference55 articles.
1. Joint United Nations Programme on HIV/AIDS. Confronting inequalities: lessons for pandemic responses from 40 years of AIDS. Geneva: UNAIDS; 2021.
2. Barr D, Garnett GP, Mayer KH, Morrison M. Key populations are the future of the African HIV/AIDS pandemic. J Int AIDS Soc. 2021;24 Suppl 3:e25750.
3. Garnett GP. Reductions in HIV incidence are likely to increase the importance of key population programmes for HIV control in sub-Saharan Africa. J Int AIDS Soc. 2021;24(Suppl 3):e25727.
4. DiCarlo MC, Dallabetta GA, Akolo C, Bautista-Arredondo S, Digolo HV, Fonner VA, et al. Adequate funding of comprehensive community-based programs for key populations needed now more than ever to reach and sustain HIV targets. J Int AIDS Soc. 2022;25(7):e25967.
5. World Health Organization. Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. Geneva: World Health Organization; 2016.
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