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

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.