Online Program

Assessing technical efficiency of HIV prevention interventions in four African countries: Methods of the orphea project

Tuesday, November 5, 2013 : 9:00 a.m. - 9:15 a.m.

Sergio Bautista Arredondo, MSc, Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
Jeanine Condo, PhD, School of Public Health, National University of Rwanda, Kigali, Rwanda
Neil Martinson, MD, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
Felix Masiye, PhD, School of Humanities and Social Science, Department of Economics, University of Zambia, Lusaka, Zambia
Sabin Nsanzimana, MD, Rwanda Biomedical Center, Kigali, Rwanda
Joseph Wang'ombe, PhD, School of Public Health, University of Nairobi, Nairobi, Kenya
Kumbutso Dzekedzeke, PhD, Dzekedzeke Research & Consultancy, Lusaka, Zambia
Omar Galarraga, PhD, Brown University, Providence
Mercy Mugo, School of Economics, University of Nairobi, Nairobi, Kenya
Richard Wamai, PhD, Department of African American Studies, Northeastern University, Boston, MA
Raluca Buzdugan, PhD, School of Public Health, University of California, Berkeley, Berkeley
Claire Chaumont, MSc, Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
Ada Kwan, MHS, Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
Ivan Ochoa, 1Division of Health Economics, Center of Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Mexico
Mead Over, Center for Global Development, Washington
Sandra G. Sosa Rubí, Division of Health Economics, Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
BACKGROUND Despite limited resources for HIV prevention interventions, few empirical studies investigate production efficiency of these services. We describe the methods of an ongoing project, which aims to assess average unit costs and determinants of efficiency for four HIV prevention interventions: prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision (VMMC), HIV testing and counseling (HTC), and HIV prevention for sex workers (SW) in Kenya, Rwanda, South Africa and Zambia.

METHODS Our research methods were developed following: i) comprehensive review of methodologies on efficiency, ii) a peer review process, iii) consultations with governments and stakeholders and, iv) comments from implementing partners.

RESULTS In each country, the study sample consists of 60-80 health facilities (40 sites per clinical-based intervention and 15 sites for SW). All relevant input costs and intervention output data are being collected for 2011 or 2012; data sources include registers, reported data, and time-motion methods. Process quality is captured from exit interviews, vignettes, and by measuring the facility's attrition rate at each stage along the service delivery cascade for each intervention. Instruments and tools were adapted to the local contexts, while still allowing cross-country comparisons.

CONCLUSIONS Reliable data on costs and efficiency are critical to best inform budget allocation and financial decisions; this requires using rigorous estimation methods. This is one of the first studies to employ a complex package of survey methods to assess technical efficiency, especially in the context of multi-country HIV studies.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs

Learning Objectives:
Discuss methods to measure technical efficiency and costs of HIV prevention interventions

Keyword(s): HIV/AIDS, Economic Analysis

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal and co-principal investigator for multiple funded grants focusing on HIV/AIDS – epidemiology, male circumcision for HIV prevention and cost efficiency of interventions – and on epidemiology, practices and policies in neglected tropical diseases, and health systems and policy in several countries across Africa. My scientific interests are in evidence-based development of strategies for preventing and responding to infectious diseases including HIV, HPV and other neglected diseases of poverty.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.