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HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya

We estimate costs and their predictors for three HIV prevention interventions in Kenya: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC). As part of the ‘Optimizing the Response of Prevention: HIV Efficiency in Afric...

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Autores principales: Galárraga, Omar, Wamai, Richard G, Sosa-Rubí, Sandra G, Mugo, Mercy G, Contreras-Loya, David, Bautista-Arredondo, Sergio, Nyakundi, Helen, Wang’ombe, Joseph K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886164/
https://www.ncbi.nlm.nih.gov/pubmed/29029086
http://dx.doi.org/10.1093/heapol/czx121
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author Galárraga, Omar
Wamai, Richard G
Sosa-Rubí, Sandra G
Mugo, Mercy G
Contreras-Loya, David
Bautista-Arredondo, Sergio
Nyakundi, Helen
Wang’ombe, Joseph K
author_facet Galárraga, Omar
Wamai, Richard G
Sosa-Rubí, Sandra G
Mugo, Mercy G
Contreras-Loya, David
Bautista-Arredondo, Sergio
Nyakundi, Helen
Wang’ombe, Joseph K
author_sort Galárraga, Omar
collection PubMed
description We estimate costs and their predictors for three HIV prevention interventions in Kenya: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC). As part of the ‘Optimizing the Response of Prevention: HIV Efficiency in Africa’ (ORPHEA) project, we collected retrospective data from government and non-governmental health facilities for 2011–12. We used multi-stage sampling to determine a sample of health facilities by type, ownership, size and interventions offered totalling 144 sites in 78 health facilities in 33 districts across Kenya. Data sources included key informants, registers and time-motion observation methods. Total costs of production were computed using both quantity and unit price of each input. Average cost was estimated by dividing total cost per intervention by number of clients accessing the intervention. Multivariate regression methods were used to analyse predictors of log-transformed average costs. Average costs were $7 and $79 per HTC and PMTCT client tested, respectively; and $66 per VMMC procedure. Results show evidence of economies of scale for PMTCT and VMMC: increasing the number of clients per year by 100% was associated with cost reductions of 50% for PMTCT, and 45% for VMMC. Task shifting was associated with reduced costs for both PMTCT (59%) and VMMC (54%). Costs in hospitals were higher for PMTCT (56%) in comparison to non-hospitals. Facilities that performed testing based on risk factors as opposed to universal screening had higher HTC average costs (79%). Lower VMMC costs were associated with availability of male reproductive health services (59%) and presence of community advisory board (52%). Aside from increasing production scale, HIV prevention costs may be contained by using task shifting, non-hospital sites, service integration and community supervision.
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spelling pubmed-58861642018-04-09 HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya Galárraga, Omar Wamai, Richard G Sosa-Rubí, Sandra G Mugo, Mercy G Contreras-Loya, David Bautista-Arredondo, Sergio Nyakundi, Helen Wang’ombe, Joseph K Health Policy Plan Original Articles We estimate costs and their predictors for three HIV prevention interventions in Kenya: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC). As part of the ‘Optimizing the Response of Prevention: HIV Efficiency in Africa’ (ORPHEA) project, we collected retrospective data from government and non-governmental health facilities for 2011–12. We used multi-stage sampling to determine a sample of health facilities by type, ownership, size and interventions offered totalling 144 sites in 78 health facilities in 33 districts across Kenya. Data sources included key informants, registers and time-motion observation methods. Total costs of production were computed using both quantity and unit price of each input. Average cost was estimated by dividing total cost per intervention by number of clients accessing the intervention. Multivariate regression methods were used to analyse predictors of log-transformed average costs. Average costs were $7 and $79 per HTC and PMTCT client tested, respectively; and $66 per VMMC procedure. Results show evidence of economies of scale for PMTCT and VMMC: increasing the number of clients per year by 100% was associated with cost reductions of 50% for PMTCT, and 45% for VMMC. Task shifting was associated with reduced costs for both PMTCT (59%) and VMMC (54%). Costs in hospitals were higher for PMTCT (56%) in comparison to non-hospitals. Facilities that performed testing based on risk factors as opposed to universal screening had higher HTC average costs (79%). Lower VMMC costs were associated with availability of male reproductive health services (59%) and presence of community advisory board (52%). Aside from increasing production scale, HIV prevention costs may be contained by using task shifting, non-hospital sites, service integration and community supervision. Oxford University Press 2017-12 2017-09-26 /pmc/articles/PMC5886164/ /pubmed/29029086 http://dx.doi.org/10.1093/heapol/czx121 Text en © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Galárraga, Omar
Wamai, Richard G
Sosa-Rubí, Sandra G
Mugo, Mercy G
Contreras-Loya, David
Bautista-Arredondo, Sergio
Nyakundi, Helen
Wang’ombe, Joseph K
HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya
title HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya
title_full HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya
title_fullStr HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya
title_full_unstemmed HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya
title_short HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya
title_sort hiv prevention costs and their predictors: evidence from the orphea project in kenya
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886164/
https://www.ncbi.nlm.nih.gov/pubmed/29029086
http://dx.doi.org/10.1093/heapol/czx121
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