Independent researcher, Geneva, Switzerland.
Division of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico.
Glob Health Sci Pract. 2023 Jun 21;11(3). doi: 10.9745/GHSP-D-22-00538.
Timely data on HIV service costs are critical for estimating resource needs and allocating funding, but few data exist on the cost of HIV services for key populations (KPs) at higher risk of HIV infection in low- and middle-income countries. We aimed to estimate the total and per contact annual cost of providing comprehensive HIV services to KPs to inform planning and budgeting decisions.
We collected cost data from the Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) program in Kenya and Malawi serving female and male sex workers, men who have sex with men, and transgender women. Data were collected prospectively for fiscal year (FY) 2019 and retrospectively for start-up activities conducted in FY2015 and FY2016. Data to estimate economic costs from the provider's perspective were collected from LINKAGES headquarters, country offices, implementing partners (IPs), and drop-in centers (DICs). We used top-down and bottom-up cost estimation approaches.
Total economic costs for FY2019 were US$6,175,960 in Kenya and US$4,261,207 in Malawi. The proportion of costs incurred in IPs and DICs was 66% in Kenya and 42% in Malawi. The costliest program areas were clinical services, management, peer outreach, and monitoring and data use. Mean cost per contact was US$127 in Kenya and US$279 in Malawi, with a mean cost per contact in DICs and IPs of US$63 in Kenya and US$104 in Malawi.
Actions undertaken above the service level in headquarters and country offices along with those conducted below the service level in communities, comprised important proportions of KP HIV service costs. The costs of pre-service population mapping and size estimation activities were not negligible. Costing studies that focus on the service level alone are likely to underestimate the costs of delivering HIV services to KPs.
及时了解艾滋病毒服务成本对于估计资源需求和分配资金至关重要，但在资源有限的国家中，针对艾滋病毒感染风险较高的关键人群（KP）的艾滋病毒服务成本数据很少。我们旨在估计为 KP 提供综合艾滋病毒服务的总年度成本和每次接触的年度成本，以为规划和预算决策提供信息。
我们从肯尼亚和马拉维的艾滋病毒服务跨连续体为受艾滋病毒影响的关键人群（LINKAGES）计划中收集了成本数据，该计划为女性和男性性工作者、男男性行为者和跨性别妇女提供服务。数据是为 2019 财年（FY）前瞻性收集的，并为 2015 财年和 2016 财年开展的启动活动进行了回顾性收集。从提供者的角度收集经济成本数据的来源包括 LINKAGES 总部、国家办事处、实施伙伴（IP）和外展中心（DIC）。我们使用自上而下和自下而上的成本估算方法。
2019 财年肯尼亚的总经济成本为 6175960 美元，马拉维为 4261207 美元。肯尼亚 IP 和 DIC 的成本占比为 66%，马拉维为 42%。成本最高的项目领域是临床服务、管理、同伴外展以及监测和数据使用。肯尼亚每名接触者的平均成本为 127 美元，马拉维为 279 美元，肯尼亚 DIC 和 IP 每名接触者的平均成本分别为 63 美元和 104 美元。
总部和国家办事处开展的服务级别以上的行动以及社区开展的服务级别以下的行动，构成了 KP 艾滋病毒服务成本的重要组成部分。服务前人口绘图和规模估计活动的成本不容忽视。仅关注服务水平的成本研究可能会低估向 KP 提供艾滋病毒服务的成本。
