142nd APHA Annual Meeting and Exposition

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Assessing Technical Efficiency of HIV Prevention Interventions in four African Countries

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 9:30 AM - 9:45 AM

Sergio Bautista Arredondo, MSc , Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
Sandra Sosa-Rubi, PhD , 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 , Division 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
Richard Wamai, PhD , Department of African American Studies, Northeastern University, Boston, MA
Jenny Coetzee , Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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 Moreno, MSc , Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
     
Audio (mp3) recording Recorded Presentation (mp4)
INTRODUCTION

Evidence on the efficiency of HIV prevention interventions is limited. ORPHEA project aimed to estimate average costs and analyse their heterogeneity for three HIV prevention interventions: prevention of mother-to-child transmission (PMTCT), voluntary medical male-circumcision (VMMC), and HIV-testing and counseling (HTC), in Kenya,  Zambia, Rwanda and South-Africa.

METHODS

Sample comprises of 60-80 clinics per country. Micro-costing was performed and relevant costs (personnel, supplies, utilities, equipment and property) and intervention-output data were collected retrospectively for 2011/2012. Information on time-allocation, building-space-used and time-motion is also collected . Quality is captured by measuring the facility’s attrition rate at each stage along the service delivery, using provider-vignettes and patient-exit-interviews. We estimated average-cost per each HIV prevention intervention.

RESULTS

Estimated weighted-average costs were US$18.1 per HTC client, US$50.1 per women tested in PMTCT services, US$93.4 per MC client. Staff costs account for more than 80% of the average costs in each prevention intervention. Variation in average cost for HTC and PMTCT by facility type is limited, except for faith-based hospitals. VMMC costs show important variations among different type of facilities, resulting cheaper to perform VMMC intervention in health centres.

CONCLUSIONS                                                                                  

Results suggest that there is a large potential to increase efficiency within the current financial and structural constraints of the health system in some countries in Africa. Staff accounts for the larger proportion of average-costs and offer the highest potential to implement actions to increase efficiency and quality. There is also need to explore different types of service delivery-models and their impacts on efficiency.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
Analyze the determinants and constraints of technical efficiency in producing HIV prevention services in a context of limited resources

Keyword(s): Economic Analysis, Health Care Costs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: She is a health economist and researcher of the National Institute of Public Health in Mexico. She is the local PI of the project economic incentives to prevent HIV among male sex workers in Mexico, and is currently leading the development of a baseline survey of MSM in Mexico at the national level. Recently, she has been involved in analyzing the efficiency of the delivery of HIV-prevention interventions in 5 countries in Africa.
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.

Back to: 5058.0: HIV Prevention in Africa