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ORIGINAL ARTICLE
Open Access

The Cost of Providing Comprehensive HIV Services to Key Populations: An Analysis of the LINKAGES Program in Kenya and Malawi

Marjorie Opuni, Jose Luis Figueroa, Jorge Eduardo Sanchez-Morales, Andrea Salas-Ortiz, Luz Edith Ochoa-Sanchez, Mariana Morales-Vazquez, Louis Masankha Banda, Alice Olawo, Spy Munthali, Julius Korir, Meghan DiCarlo, Navindra Persaud and Sergio Bautista-Arredondo
Global Health: Science and Practice June 2023, 11(3):e2200538; https://doi.org/10.9745/GHSP-D-22-00538
Marjorie Opuni
aIndependent researcher, Geneva, Switzerland.
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Jose Luis Figueroa
bDivision of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico.
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Jorge Eduardo Sanchez-Morales
bDivision of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico.
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Andrea Salas-Ortiz
cCentre for Health Economics, University of York, York, United Kingdom.
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Luz Edith Ochoa-Sanchez
bDivision of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico.
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Mariana Morales-Vazquez
bDivision of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico.
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Louis Masankha Banda
dFHI 360, Lilongwe, Malawi.
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Alice Olawo
eFHI 360, Nairobi, Kenya.
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Spy Munthali
fUniversity of Malawi, Zomba, Malawi.
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Julius Korir
gKenyatta University, Nairobi, Kenya.
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Meghan DiCarlo
hFHI 360, Durham, NC, USA.
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Navindra Persaud
hFHI 360, Durham, NC, USA.
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Sergio Bautista-Arredondo
bDivision of Health Economics and Health Systems Innovations, National Institute of Public Health, Cuernavaca, Mexico.
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  • For correspondence: sbautista{at}insp.mx
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    FIGURE 1

    LINKAGES Program Start-Up Costs by Country and Program Implementation Level, FY2015 and FY2016a

    Abbreviations: FY, fiscal year; LINKAGES, Linkages across the Continuum of HIV Services for Key Populations Affected by HIV; US$, U.S. dollars.

    aHeadquarters refers to LINKAGES program headquarters, country office refers to LINKAGES program country office, and subawards refers to grants given to implementing partners in countries. FY 2015 refers to U.S. Government fiscal year from October 1, 2014 to September 30, 2015. FY2016 refers to U.S. Government fiscal year from October 1, 2015 to September 30, 2016.

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    FIGURE 2

    Total Economic Costs of LINKAGES Program by Country, Type of Input, and DIC, FY2019a

    Abbreviations: DIC, drop-in center; FY, fiscal year; IP, implementing partner; LINKAGES, Linkages across the Continuum of HIV Services for Key Populations Affected by HIV.

    a Each letter number combination on the y-axis represents a DIC with the letters representing the associated IP. FY2019 refers to U.S. Government fiscal year from October 1, 2018 to September 30, 2019.

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    TABLE 1.

    Total Economic Costs of LINKAGES Program by Country, Program Area, and Program Implementation Level, FY2019a

    Program AreasKenya Total Costs, US$Malawi Total Costs, US$
    HQCOIP/DICTotal (%)HQCOIP/DICTotal (%)
    KP size estimationb35,57678,79590,831205,203 (3)36,617135,13672,754244,507 (6)
    KP empowermentc30,059151,71385,432267,205 (4)35,96999,64571,052206,666 (5)
    Structural interventions31,34198,57387,804217,719 (4)25,15043,24448,405116,799 (3)
    Peer outreach86,46472,148671,587830,198 (13)95,771242,535318,434656,740 (15)
    Clinical services221,88859,5232,147,1902,428,601 (39)307,642228,193672,0741,207,909 (28)
    Management135,519670,179549,2431,354,940 (22)185,267407,268337,930930,464 (22)
    Monitoring and data use135,088161,060381,860678,008 (11)110,439237,615214,760562,814 (13)
    Start-up costs46,58189,28058,226194,086 (3)107,298187,77240,237335,307 (8)
    Total (%)d722,516 (12)1,381,272 (22)4,072,173 (66)6,175,960 (100)904,153 (21)1,581,409 (37)1,775,645 (42)4,261,207 (100)
    • Abbreviations: CO, country office; DIC, drop-in center; FY, fiscal year; HQ, headquarters; IP, implementing partner; KP, key population; LINKAGES, Linkages across the Continuum of HIV Services for Key Populations Affected by HIV; US$, U.S. dollars.

    • ↵a U.S. Government fiscal year from October 1, 2018 to September 30, 2019.

    • ↵b Engaging KPs in population size estimation, mapping, and program planning.

    • ↵c KP empowerment and engagement.

    • ↵d Numbers may not add up due to rounding.

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    TABLE 2.

    Total Economic Costs of LINKAGES Program per Type of Input at the IP/DIC Level, FY2019a

    InputsKenya Total Costs, US$ (%)Malawi Total Costs, US$ (%)
    Clinical supplies1,644,707 (41)262,096 (15)
    Staff1,142,154 (28)1,058,690 (61)
    Peer workers447,426 (11)183,757 (11)
    Transportation66,466 (2)6,957 (0)b
    Other recurrent625,826 (16)166,637 (10)
    Equipment26,341 (1)16,937 (1)
    Training61,026 (2)40,333 (2)
    Total IP/DIC (%)c4,013,947 (100)1,735,407 (100)
    • Abbreviations: DIC, drop-in center; FY, fiscal year; IP, implementing partner; LINKAGES, Linkages across the Continuum of HIV Services for Key Populations Affected by HIV; US$, U.S. dollars.

    • ↵a U.S. Government fiscal year from October 1, 2018 to September 30, 2019.

    • ↵b Amount equal to 0.4%.

    • ↵c Numbers may not add up due to rounding.

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    TABLE 3.

    Number of LINKAGES Program Contacts and Costs per Contact by Country and Service Level, FY2019a

    KenyaMalawi
    Number of DICs3015
    Number of contactsb
     Mean (SD)6,347 (12,205)1,184 (436)
     Range422–51,823570–2,159
     Median (IQR)2,326 (2,461)1,140 (413)
    Cost per contact,b US$
    Headquarters and country office level
     Mean (SD)44 (39)161 (59)
     Range1–17178–295
     Median (IQR)31 (41)148 (58)
    Implementing partner/drop-in center level
     Mean (SD)63 (55)104 (23)
     Range5–31179–151
     Median (IQR)54 (39)94 (38)
    Total
     Mean (SD)127 (102)279 (79)
     Range10–554180–455
     Median (IQR)119 (75)255 (116)
    • Abbreviations: DIC, drop-in center; FY, fiscal year; IQR, interquartile range; LINKAGES, Linkages across the Continuum of HIV Services for Key Populations Affected by HIV; SD, standard deviation; US$, U.S. dollars.

    • ↵a U.S. Government fiscal year from October 1, 2018 to September 30, 2019.

    • ↵b Mean (SD), range, and median (IQR) calculated across all DICs in the sample for each country.

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The Cost of Providing Comprehensive HIV Services to Key Populations: An Analysis of the LINKAGES Program in Kenya and Malawi
Marjorie Opuni, Jose Luis Figueroa, Jorge Eduardo Sanchez-Morales, Andrea Salas-Ortiz, Luz Edith Ochoa-Sanchez, Mariana Morales-Vazquez, Louis Masankha Banda, Alice Olawo, Spy Munthali, Julius Korir, Meghan DiCarlo, Navindra Persaud, Sergio Bautista-Arredondo
Global Health: Science and Practice Jun 2023, 11 (3) e2200538; DOI: 10.9745/GHSP-D-22-00538

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The Cost of Providing Comprehensive HIV Services to Key Populations: An Analysis of the LINKAGES Program in Kenya and Malawi
Marjorie Opuni, Jose Luis Figueroa, Jorge Eduardo Sanchez-Morales, Andrea Salas-Ortiz, Luz Edith Ochoa-Sanchez, Mariana Morales-Vazquez, Louis Masankha Banda, Alice Olawo, Spy Munthali, Julius Korir, Meghan DiCarlo, Navindra Persaud, Sergio Bautista-Arredondo
Global Health: Science and Practice Jun 2023, 11 (3) e2200538; DOI: 10.9745/GHSP-D-22-00538
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