Background: In Uganda, women engaged in sex work (WESW) have an HIV prevalence of 31.3% and account for 18% of all new HIV infections in the country. This marginalized population is at the intersection of multiple vulnerabilities, including gender inequality, gender-based violence, financial instability, stigma, and poor access to HIV preventions. The Kyaterekera intervention is targeted at WESW in Rakai and the greater Masaka regions in Uganda and combines a traditional HIV risk reduction (HIVRR) approach with a savings-led economic empowerment intervention and financial literacy training (FLT).

Methods: This study estimated the economic costs of the Kyaterekera intervention from a program provider perspective using a prospective activity-based micro-costing method. All program activities and associated resource use were identified, measured, and valued across the two study arms: 1) control arm (n=7 clusters, 186 women) receiving a traditional HIVRR intervention; 2) treatment arm (n=12 clusters, 356 women) receiving a matched individual development savings account (IDA) and FLT on top HIVRR. Estimated costs were summed per each arm and divided by actual participant numbers to calculate the total per-participant cost by arm. All costs were adjusted for inflation, discounted at an annual rate of 3% to the start year of the intervention, and presented in 2019 US dollars.

Results: The total per-participant cost of HIVRR and HIVRR+IDA+FLT arms was estimated at $323 and $1,435, respectively, using the treatment-on-the-treated (TOT) sample. When calculated based on the intent-to-treat (ITT) sample, the per-participant costs were reduced to $183 and $588, respectively. The key cost drivers were the capital invested in IDAs at opening and through matched contributions and the personnel and transportation costs for program operations, linked to WESW’s higher mobility and the dispersed pattern of hot spot locations.

Conclusions: This is the first study to estimate the costs of a combined HIVRR and economic empowerment intervention for WESW in Uganda. The findings contribute to a dearth of evidence on the economic costs of implementing a targeted intervention for this marginalized population in resource-constrained settings and sheds light on the scale of potential investment needed to better achieve the health equity goal of HIV prevention strategies.