Dandona L, Sisodia P, Ramesh Y K, Kumar S G P, Kumar A A, Rao M C, Someshwar M, Hansl B, Marshall N, Marseille E, Kahn J G
Centre for Public Health Research, Administrative Staff College of India, Raj Bhavan Road, Hyderabad 500082, Andhra Pradesh, India.
Natl Med J India. 2005 Jan-Feb;18(1):26-31.
[corrected] As part of the effort to control HIV/AIDS, the number of HlV voluntarycounselling and testingcentres (VCTCs) is increasing rapidly in the public health system of the Indian state of Andhra Pradesh, which is estimated to have one of the highest rates of HIV infection in India. However, systematic data on the cost and efficiency of providing VCT services in India are not available to help guide efficient use of resources for these services.
We used standardized methods to obtain detailed cost and output data for the 2002-03 fiscal year from written records and interviews in 17 VCTCs in the public health system in Andhra Pradesh. We calculated the economic cost per client receiving VCT services, and analysed the variation and determinants of total and unit costs across VCTCs. We used multivariate regression techniques to estimate incremental unit costs. We assessed hurdles towards serving an optimal number of clients by VCTCs.
In the 2002-03 fiscal year, 32 413 clients received the complete sequence of services at the 17 VCTCs, including post-HIV test counselling. The number of clients served by each VCTC ranged from 334 to 7802 (median 979). The overall HIV-positive rate in post-test counselled clients was 20.5% (range 5.4%-52.6%). The cost per client for the complete VCT sequence varied 6-fold between VCTCs (range Rs 141.5-829.6 [US 2.92-17.14 dollars], median Rs 363.5 [US 7.51 dollars]). The cost per client was significantly lower at VCTCs with more clients (p < 0.001, R2 = 0.83; power function) due to substantial fixed costs. Personnel made up the largest component of cost (53.7%). The cost per client had a significant direct relation with percent personnel cost for VCTCs (p < 0.001, R2 = 0.58; exponential function). A multiple regression model revealed that the incremental cost of providing complete VCT services to each HIV-positive and -negative client was Rs 123.5 (US 2.54 dollars) and Rs 59.2 (US 1.22 dollars), respectively. Fourteen VCTCs (82.4%) reported that they could serve more clients with the available personnel and infrastructure, and that inadequate demand for their services was the main hurdle towards achieving this.
These data suggest that the efforts of the National AIDS Control Organisation of India and the Andhra Pradesh State AIDS Control Society in increasing VCTCs could yield even higher benefit if the demand for these services was enhanced, as this would increase the number of clients served and reduce the cost per client. Ongoing systematic cost-efficiency analysis is necessary to help guide efficient use of HIV-control resources in India.
作为控制艾滋病毒/艾滋病工作的一部分，印度安得拉邦公共卫生系统中艾滋病毒自愿咨询和检测中心（VCTCs）的数量正在迅速增加，该邦估计是印度艾滋病毒感染率最高的地区之一。然而，印度缺乏关于提供VCT服务的成本和效率的系统数据，无法帮助指导这些服务资源的有效利用。
我们采用标准化方法，从安得拉邦公共卫生系统中17个VCTCs的书面记录和访谈中获取2002 - 03财政年度的详细成本和产出数据。我们计算了接受VCT服务的每位客户的经济成本，并分析了各VCTCs总成本和单位成本的差异及决定因素。我们使用多元回归技术来估计增量单位成本。我们评估了VCTCs服务最佳客户数量的障碍。
在2002 - 03财政年度，17个VCTCs为32413名客户提供了包括艾滋病毒检测后咨询在内的完整服务序列。每个VCTCs服务的客户数量从334到7802不等（中位数为979）。检测后接受咨询的客户中艾滋病毒总体阳性率为20.5%（范围为5.4% - 52.6%）。完整VCT序列的每位客户成本在各VCTCs之间相差6倍（范围为141.5 - 829.6卢比[2.92 - 17.14美元]，中位数为363.5卢比[7.51美元]）。由于大量固定成本，客户较多的VCTCs每位客户的成本显著更低（p < 0.001，R2 = 0.83；幂函数）。人员成本占成本的最大部分（53.7%）。每位客户的成本与VCTCs的人员成本百分比有显著直接关系（p < 0.001，R2 = 0.58；指数函数）。多元回归模型显示，为每位艾滋病毒阳性和阴性客户提供完整VCT服务的增量成本分别为123.5卢比（2.54美元）和59.2卢比（1.22美元）。14个VCTCs（82.4%）报告称，以现有的人员和基础设施，他们可以服务更多客户，但服务需求不足是实现这一目标的主要障碍。
这些数据表明，如果增加对这些服务的需求，印度国家艾滋病控制组织和安得拉邦艾滋病控制协会增加VCTCs的努力可能会带来更高的效益，因为这将增加服务的客户数量并降低每位客户的成本。持续进行系统的成本效益分析对于指导印度艾滋病毒控制资源的有效利用是必要的。
