The Costs of Scaling Up HIV Prevention for High Risk Groups: Lessons Learned from the Avahan Programme in India |
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| Authors: | Sudhashree Chandrashekar Lorna Guinness Michael Pickles Govindraj Y. Shetty Michel Alary Peter Vickerman CHARME–1 Evaluation Group Anna Vassall |
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| Affiliation: | 1. London School of Hygiene and Tropical Medicine, London, United Kingdom.; 2. St John''s Research Institute, Bangalore, India.; 3. Imperial College, London, United Kingdom.; 4. Karnataka Health Promotion Trust, Bangalore, India.; 5. URESP, Centre de recherchedu CHU de Quebec, Quebec, Canada.; 6. Département de médecine sociale et préventive, Université Laval, Québec, Canada.; University of Washington, United States of America, |
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| Abstract: | ObjectiveThe study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond.DesignProspective costing study.MethodsThis study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$ 2011.ResultsMean total unit costs (2004–08) per person reached at least once a year and per monthly contact were US$ 235(56–1864) and US$ 82(12–969) respectively. 35% of the cost was incurred by NGOs, 30% at the state level SLP and 35% at the national programme level. The proportion of total costs by activity were 34% for expertise enhancement, 37% for programme management (including support and supervision), 22% for core HIV prevention activities (outreach and STI services) and 7% for community mobilisation and enabling environment activities. Total unit cost per person reached fell sharply as the programme expanded due to declining unit costs above the service level (from US$ 477 per person reached in 2004 to US$ 145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached.ConclusionsScaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities. |
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