aCenter for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA bCenter for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya cBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco dIbis Reproductive Health, Oakland, California, USA.
AIDS. 2013 Oct;27 Suppl 1:S87-92. doi: 10.1097/QAD.0000000000000038.
To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services.
Integration of family planning services into HIV care and treatment clinics.
A cluster-randomized trial.
Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services.
We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization.
We collected cost data through interviews with study staff and review of financial records to determine costs of service integration.
Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted.
Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.
评估将计划生育纳入艾滋病毒服务的成本、成本效益和成本效果。
将计划生育服务纳入艾滋病毒护理和治疗诊所。
一项整群随机试验。
肯尼亚 Nyanza 的 12 个卫生机构被随机分配将计划生育纳入艾滋病毒护理和治疗；6 个卫生机构被随机分配到（非综合）标准护理，提供单独的计划生育和艾滋病毒服务。
我们评估了将计划生育纳入艾滋病毒护理的第一年的相关成本、成本效益（每增加一种更有效的计划生育方法的使用成本）和成本效果（每避免一次妊娠的成本）。更有效的计划生育方法包括口服和注射避孕药、皮下埋植剂、宫内节育器以及女性和男性绝育。
我们通过采访研究人员和审查财务记录收集了服务整合成本数据，以确定服务整合的成本。
服务整合平均每个地点的边际成本为 841 美元，每位女性患者的成本为 48 美元。整合的平均总边际成本与人员成本有关[初始（1003 美元对 872 美元）和进修（498 美元对 330 美元）培训、指导（1175 美元对 902 美元）和监督（1694 美元对 1636 美元）]，其他固定（18 美元对 0 美元）和经常性费用（471 美元对 287 美元）所需资源较少。整合与每增加一种更有效的计划生育方法的边际成本为 65 美元，每避免一次妊娠的成本为 1368 美元。
在肯尼亚，将计划生育和艾滋病毒服务相结合是可行的，实施成本低廉且具有成本效益，因此支持当前肯尼亚的整合政策。
