Assessing cost and technical efficiency of HIV prevention interventions in sub-Saharan Africa: the ORPHEA study design and methods

BMC Health Services Research

Joseph Wang’ombe⁸  Richard Wamai⁴  Sabin Nsanzimana⁹  Felix Masiye⁵  Neil Martinson³  Omar Galárraga⁷  Kumbutso Dzekedzeke¹  Jeanine Condo^1,10  Jenny Coetzee³  Claire Chaumont⁶  Ada Kwan⁶  Marjorie Opuni²  Sandra G Sosa-Rubí⁶  Sergio Bautista-Arredondo⁶ 

[1] Dzekdzeke Research & Consultancy, Lusaka, Zambia;UNAIDS, Geneva, Switzerland;Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa;Northeastern University, Boston, USA;University of Zambia, Division of Economics, Lusaka, Zambia;National Institute of Public Health (INSP), Division of Health Economics, Cuernavaca, Mexico;Brown University, Providence, USA;University of Nairobi, School of Public Health, Nairobi, Kenya;Rwanda Biomedical Center, Kigali, Rwanda;National University of Rwanda, School of Public Health, Kigali, Rwanda

关键词: Sex workers;    PMTCT;    Male circumcision;    Testing;    Prevention;    AIDS;    HIV;    Technical efficiency;    Economic evaluation;    Cost;   

Others  :  1090656
DOI  :  10.1186/s12913-014-0599-9

 received in 2014-10-07, accepted in 2014-11-12,  发布年份 2014

【 摘 要 】

Background

Scaling up services to achieve HIV targets will require that countries optimize the use of available funding. Robust unit cost estimates are essential for the better use of resources, and information on the heterogeneity in the unit cost of delivering HIV services across facilities – both within and across countries – is critical to identifying and addressing inefficiencies. There is limited information on the unit cost of HIV prevention services in sub-Saharan Africa and information on the heterogeneity within and across countries and determinants of this variation is even more scarce. The “Optimizing the Response in Prevention: HIV Efficiency in Africa” (ORPHEA) study aims to add to the empirical body of knowledge on the cost and technical efficiency of HIV prevention services that decision makers can use to inform policy and planning.

Methods/Design

ORPHEA is a cross-sectional observational study conducted in 304 service delivery sites in Kenya, Rwanda, South Africa, and Zambia to assess the cost, cost structure, cost variability, and the determinants of efficiency for four HIV interventions: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision (VMMC), and HIV prevention for sex workers. ORPHEA collected information at three levels (district, facility, and individual) on inputs to HIV prevention service production and their prices, outputs produced along the cascade of services, facility-level characteristics and contextual factors, district-level factors likely to influence the performance of facilities as well as the demand for HIV prevention services, and information on process quality for HTC, PMTCT, and VMMC services.

Discussion

ORPHEA is one of the most comprehensive studies on the cost and technical efficiency of HIV prevention interventions to date. The study applied a robust methodological design to collect comparable information to estimate the cost of HTC, PMTCT, VMMC, and sex worker prevention services in Kenya, Rwanda, South Africa, and Zambia, the level of efficiency in the current delivery of these services, and the key determinants of efficiency. The results of the study will be important to decision makers in the study countries as well as those in countries facing similar circumstances and contexts.

【 授权许可】

   
2014 Bautista-Arredondo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]The world health report: health systems financing: the path to universal coverage. World Health Organization, Geneva; 2010.
• [2]Bautista-Arredondo S, Gadsden P, Harris JE, Bertozzi SM: Optimizing resource allocation for HIV/AIDS prevention programmes: an analytical framework. AIDS 2008, 22(Suppl 1):S67-S74.
• [3]Bautista-Arredondo S, Martz TE, Wirtz VJ, Bertozzi SM: Optimizing HIV treatment programs. Curr Opin HIV AIDS 2010, 5(3):232-236.
• [4]Schwartlander B, Stover J, Hallett T, Atun R, Avila C, Gouws E, Bartos M, Ghys PD, Opuni M, Barr D, Alsallaq R, Bollinger L, de Freitas M, Garnett G, Holmes C, Legins K, Pillay Y, Stanciole AE, McClure C, Hirnschall G, Laga M, Padian N: Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 2011, 377(9782):2031-2041.
• [5]Global report: UNAIDS report on the global AIDS epidemic. Joint United Nations Programme on HIV/AIDS, Geneva; 2013.
• [6]Together we will end AIDS. Joint United Nations Programme on HIV/AIDS, Geneva; 2012.
• [7]Vassall A, Remme M, Watts C, Hallett T, Siapka M, Vickerman P, Terris-Prestholt F, Haacker M, Heise L, Haines A, Atun R, Piot P: Financing essential HIV services: a new economic agenda. PLoS Med 2013, 10(12):e1001567.
• [8]Bertozzi SM, Laga M, Bautista-Arredondo S, Coutinho A: Making HIV prevention programmes work. Lancet 2008, 372(9641):831-844.
• [9]Siapka M, Remme M, Obure CD, Maier CB, Dehne KL, Vassall A: Is there scope for cost savings and efficiency gains in HIV services? A systematic review of the evidence from low- and middle-income countries. Bull World Health Organ 2014, 92(7):499-511. AD
• [10]Marseille E, Dandona L, Marshall N, Gaist P, Bautista-Arredondo S, Rollins B, Bertozzi SM, Coovadia J, Saba J, Lioznov D, Du Plessis JA, Krupitsky E, Stanley N, Over M, Peryshkina A, Kumar SG, Muyingo S, Pitter C, Lundberg M, Kahn JG: HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries. BMC Health Serv Res 2007, 7:108. BioMed Central Full Text
• [11]Marseille E, Dandona L, Saba J, McConnel C, Rollins B, Gaist P, Lundberg M, Over M, Bertozzi S, Kahn JG: Assessing the efficiency of HIV prevention around the world: methods of the PANCEA project. Health Serv Res 2004, 39(6 Pt 2):1993-2012.
• [12]Obure CD, Vassall A, Michaels C, Terris-Prestholt F, Mayhew S, Stackpool-Moore L, Warren C, Watts C: Optimising the cost and delivery of HIV counselling and testing services in Kenya and Swaziland. Sex Transm Infect 2012, 88(7):498-503.
• [13]Aliyu HB, Chuku NN, Kola-Jebutu A, Abubakar Z, Torpey K, Chabikuli ON: What is the cost of providing outpatient HIV counseling and testing and antiretroviral therapy services in selected public health facilities in Nigeria? J Acquir Immune Defic Syndr 2012, 61(2):221-225.
• [14]Bratt JH, Torpey K, Kabaso M, Gondwe Y: Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities. Trop Med Int Health 2011, 16(1):110-118.
• [15]Siregar AY, Komarudin D, Wisaksana R, van Crevel R, Baltussen R: Costs and outcomes of VCT delivery models in the context of scaling up services in Indonesia. Trop Med Int Health 2011, 16(2):193-199.
• [16]Dandona L, Kumar SG, Ramesh YK, Rao MC, Marseille E, Kahn JG, Dandona R: Outputs, cost and efficiency of public sector centres for prevention of mother to child transmission of HIV in Andhra Pradesh. India. BMC Health Serv Res 2008, 8:26. BioMed Central Full Text
• [17]Marseille E, Kahn JG, Beatty S, Jared M, Perchal P: Adult male circumcision in Nyanza, Kenya at scale: the cost and efficiency of alternative service delivery modes. BMC Health Serv Res 2014, 14:31. BioMed Central Full Text
• [18]Galarraga O, Wirtz VJ, Figueroa-Lara A, Santa-Ana-Tellez Y, Coulibaly I, Viisainen K, Medina-Lara A, Korenromp EL: Unit costs for delivery of antiretroviral treatment and prevention of mother-to-child transmission of HIV: a systematic review for low- and middle-income countries. Pharmacoeconomics 2011, 29(7):579-599.
• [19]Sweeney S, Obure CD, Maier CB, Greener R, Dehne K, Vassall A: Costs and efficiency of integrating HIV/AIDS services with other health services: a systematic review of evidence and experience. Sex Transm Infect 2012, 88(2):85-99.
• [20]Johns B, Torres TT: Costs of scaling up health interventions: a systematic review. Health Policy Plan 2005, 20(1):1-13.
• [21]Bratt JH, Foreit J, Chen PL, West C, Janowitz B, de Vargas T: A comparison of four approaches for measuring clinician time use. Health Policy Plan 1999, 14(4):374-381.
• [22]Jones A, Cremin I, Abdullah F, Idoko J, Cherutich P, Kilonzo N, Rees H, Hallett T, O'Reilly K, Koechlin F, Schwartlander B, de Zalduondo B, Kim S, Jay J, Huh J, Piot P, Dybul M: Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention. Lancet 2014, 384(9939):272-279.
• [23]Das J, Gertler PJ: Variations in practice quality in five low-income countries: a conceptual overview. Health Aff (Millwood) 2007, 26(3):w296-w309.
• [24]National guidelines for HIV/STI programmes for sex workers. Ministry of Public Health and Sanitation, Nairobi; 2010.
• [25]Drummond MF, Sculpher MJ, Torrence DW, O'Brien BJ, Stoddart GL: Methods for the economic evaluation of health care programmes. 3rd edition. Oxford University Press, Oxford; 2005.
• [26]Adam T: Sources of Variability in Costing Methods: Implications for Transferability of Cost-Effectiveness Results. PhD thesis. Erasmus University, Rotterdam; 2006.
• [27]Adam T, Amorim EG, Edwards SJ, Amaral J, Evans DB: Capacity constraints to the adoption of new interventions: consultation time and the Integrated Management of Childhood Illness in Brazil. Health Policy Plan 2005, 20(Suppl 1):i49-i57.
• [28]Bruns B, Filmer D, Patrinos HA: Making schools work: Evidence on accountability reforms. The World Bank, Washington, D.C; 2011.
• [29]Coelli T, Estache A, Perelman S, Trujillo L: A primer on efficiency measurement for utilities and transport regulators. The World Bank, Washington, D.C; 2003.
• [30]Aletras VH: A comparison of hospital scale effects in short-run and long-run cost functions. Health Econ 1999, 8(6):521-530.
• [31]Gertler PJ, Waldman D: Quality adjusted cost functions.National Bureau of Economic Research. Working Paper No. 3567 1990.
• [32]Vita MG: Exploring hospital production relationships with flexible functional forms. J Health Econ 1990, 9(1):1-21.
• [33]Smith PC, Street A: Measuring the efficiency of public services: the limits of analysis. J Roy Stat Soc a Sta 2005, 168:401-417.
• [34]Charnes A, Cooper WW, Rhodes E: Measuring Efficiency of Decision-Making Units. Eur J Oper Res 1978, 2(6):429-444.
• [35]Wagstaff A, Wang LC: A hybrid approach to efficiency measurement with empirical illustrations from education and health. In Policy Research Working Paper. The World Bank, Washington, D.C; 2011.