RT Journal Article
SR Electronic
T1 The Cost of Providing Comprehensive HIV Services to Key Populations: An Analysis of the LINKAGES Program in Kenya and Malawi
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2200538
DO 10.9745/GHSP-D-22-00538
VO 11
IS 3
A1 Opuni, Marjorie
A1 Figueroa, Jose Luis
A1 Sanchez-Morales, Jorge Eduardo
A1 Salas-Ortiz, Andrea
A1 Ochoa-Sanchez, Luz Edith
A1 Morales-Vazquez, Mariana
A1 Banda, Louis Masankha
A1 Olawo, Alice
A1 Munthali, Spy
A1 Korir, Julius
A1 DiCarlo, Meghan
A1 Persaud, Navindra
A1 Bautista-Arredondo, Sergio
YR 2023
UL http://www.ghspjournal.org/content/11/3/e2200538.abstract
AB Key FindingsActivities done at the headquarters and country office levels, as well as community outreach activities to engage key populations (KPs), comprised substantial proportions of total costs, suggesting that focusing on the costs of service delivery alone will likely underestimate the total costs of delivering HIV services to KPs.This analysis highlights the heterogeneity in costs and cost structure between Kenya and Malawi, illustrating the importance of differences in country contexts, needs, service delivery infrastructures, and capacities in influencing costs.These findings are consistent with the complexity of comprehensive KP HIV services; the levels of stigma, discrimination, and violence against KPs; and the support and oversight needs of implementing organizations.Key ImplicationsCosting studies of HIV services for KPs should consider all activities conducted at all levels of program implementation.Resource needs assessments, budgeting exercises, and ultimately, funding allocations for KP HIV services in low-resource settings that only rely on service-level costs are based on flawed cost estimates.Introduction: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.Methods: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.Results: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.Conclusion: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.