Changing cost of HIV interventions in the context of scaling-up in India

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Changing cost of HIV interventions in the context of scaling-up in

India

[A copy of the article is available from the editor of the FORUM]

Lalit Dandonaa, , S.G. Prem Kumara,, Y.K. Rameshb,M, M. Chalapathi

Raob, A. Anod Kumarb, Elliot Marseilled, G. Kahnd and Rakhi

Dandonaa, AIDS 2008, 22 (suppl 1):S43–S49

Background: A rapid scaling up of HIV interventions in India is

anticipated, but systematic information on how costs of HIV interventions change

over time and programme scale is not available to inform planning.

Methods: We studied the changes in unit costs of two major

interventions, voluntary counseling and testing (VCT) and sex worker programmes

in the south Indian state of Andhra Pradesh between 2002–2003 and 2005–2006

fiscal years. Economic costs (from the provider perspective) and output data

from 17 publicly funded VCT centers

and 14 sex worker programmes were collected using standardized

methods. We calculated unit costs for each programme in each period and explored

possible reasons for the changes seen.

Results: In 2005–2006, the VCT centers served 66 445 clients and the

sex worker programmes served 32 550. The unit cost of providing VCT dropped over

3 years by half to Indian Rupees (INR) 147.5 (US$3.33) mainly because the number

of clients doubled.

There was no decrease in the average time spent counseling each

client. The unit cost of providing services to sex workers increased 2.4 times

over 3 years to INR 1401 (US$31.6) as a result of increases in male condom

distribution, staff salaries and training, and treatment for sexually

transmitted infections, all suggesting improved

services.

Conclusion: The unit cost of these two interventions changed

dramatically over a 3-year period, but in opposite directions. The current unit

cost for VCT in Andhra Pradesh is much lower than the estimated global average

for low- income settings. These

local longitudinal cost data are useful to inform the currently

planned scaling up of HIV interventions in India.

2008 Wolters Kluwer Health | Lippincott & Wilkins

AIDS 2008, 22 (suppl 1):S43–S49

Correspondence to Lalit Dandona, Institute for International

Health – India, 839C, Road No. 44A, Jubilee Hills, Hyderabad 500 033,

India. E-mail: LDandona@...