Bautista-Arrendondo, D., Sosa-Rubi, S.G., Opuni, M., et al. AIDS (2016), doi: 10.1097/QAD.0000000000001208
This study examined 230 HIV testing and counseling (HTC) and 212 prevention of mother-to-child transmission (PMTCT) sites to examine site-level average yearly cost per client along the cascades in Kenya, Rwanda, South Africa, and Zambia. Retrospective data was collected from facility records covering a period of one year. Data collection include five cost categories including personnel, recurrent inputs and services, equipment and vehicle operating costs, training, and supervision. For HTC, average yearly cost per client tested ranged from USD$5 to $31, and $122 to $1,367 per HIV-positive client. Costs ranged widely between and within countries with some facilities skewing results with higher costs. On average, cost per HTC client in South Africa and Zambia was significantly higher than in Rwanda and Kenya. Average cost per PMTCT client ranged from $18–89 and $565–$2,021 per HIV-positive client. Average cost per PMTCT client was significantly less in Rwanda than other countries and per HIV-positive client, significantly higher in Rwanda than Kenya and Zambia. For HTC and PMTCT, per HIV-positive client average cost in Rwanda was significantly higher due to the low positivity rate encountered. Staffing for HTC and PMTCT comprised the majority of costs in all countries with the exception of PMTCT in Rwanda. Study findings indicated that improving intervention targeting, altering staffing, or adapting service models could improve efficiency.