What Determines HIV Prevention Costs at Scale? Evidence from the Avahan Programme in India

March 2016 - Structural Prevention

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Lépine, A., Chandrashekar, S., Shetty, G., et al. Health Economics (February 2016), 25(1):67–82, doi: 10.1002/hec.3296.

To inform the design of HIV programs that provide grants to nongovernmental organizations (NGOs), the authors collected economic costs of HIV prevention delivered during the first four years of the Indian Avahan initiative, the world's largest HIV prevention project. Avahan has produced one of the largest cost datasets globally, collected from 138 NGOs in 64 districts of four Indian states from 2004 to 2007. The program monitored all recurrent costs (personnel, building operating expenses, travel, supplies for addressing sexually transmitted infections or STIs, monitoring, outreach and training, condom supplies, and indirect expenses) and capital costs (buildings, equipment, furniture, vehicles, initial training, insurance and deposits, and start-up). For each participating NGO, costs were disaggregated by activity and input type. The authors found that program design characteristics (such as NGO size, community involvement, the quality of outreach, and STI service delivery strategy) significantly influenced average costs; environmental or population influences had less impact. Higher total costs did not necessarily suggest increased inefficiency. Sometimes, higher total costs included technical assistance that improved efficiency at the NGO level by enhancing service quality. The authors urged program managers to consider these findings when designing and implementing HIV prevention and other public health programs to ensure that the greatest number of beneficiaries can receive essential services using the resources available.

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