Estimating the Cost of HIV Services for Key Populations Provided by the LINKAGES Program in Kenya and Malawi
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Date
2023
Authors
Opuni, Marjorie
Sanchez‑Morales, Jorge Eduardo
Figueroa, Jose Luis
Salas‑Ortiz, Andrea
Banda, Louis Masankha
Olawo, Alice
Munthali, Spy
Korir, Julius
DiCarlo, Meghan
Bautista‑Arredondo, Sergio
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Health Services Research
Abstract
Background Data remain scarce on the costs of HIV services for key populations (KPs). The objective of this study
was to bridge this gap in the literature by estimating the unit costs of HIV services delivered to KPs in the LINKAGES
program in Kenya and Malawi. We estimated the mean total unit costs of seven clinical services: post-exposure
prophylaxis (PEP), pre-exposure prophylaxis (PrEP), HIV testing services (HTS), antiretroviral therapy (ART), sexually
transmitted infection (STI) services, sexual and reproductive health (SRH) services, and management of sexual vio‑
lence (MSV). These costs take into account the costs of non-clinical services delivered alongside clinical services and
the pre-service and above-service program management integral to the LINKAGES program.
Methods Data were collected at all implementation levels of the LINKAGES program including 30 drop-in-centers
(DICs) in Kenya and 15 in Malawi. This study was conducted from the provider’s perspective. We estimated eco‑
nomic costs for FY 2019 and cost estimates include start-up costs. Start-up and capital costs were annualized using a
discount rate of 3%. We used a combination of top-down and bottom-up costing approaches. Top-down methods
were used to estimate the costs of headquarters, country ofces, and implementing partners. Bottom-up microcosting methods were used to measure the quantities and prices of inputs used to produce services in DICs. Volumeweighted mean unit costs were calculated for each clinical service. Costs are presented in 2019 United States dollars
(US$).
Results The mean total unit costs per service ranged from US$18 (95% CI: 16, 21) for STI services to US$635 (95% CI:
484, 785) for PrEP in Kenya and from US$41 (95% CI: 37, 44) for STI services to US$1,240 (95% CI 1156, 1324) for MSV in
Malawi. Clinical costs accounted for between 21 and 59% of total mean unit costs in Kenya, and between 25 and 38%
in Malawi. Indirect costs—including start-up activities, the costs of KP interventions implemented alongside clinical
services, and program management and data monitoring—made up the remaining costs incurred.
Conclusions A better understanding of the cost of HIV services is highly relevant for budgeting and planning
purposes and for optimizing HIV services. When considering all service delivery costs of a comprehensive HIV service package for KPs, costs of services can be signifcantly higher than when considering direct clinical service costs alone.
These estimates can inform investment cases, strategic plans and other budgeting exercises.
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Citation
Opuni, M., Sanchez-Morales, J. E., Figueroa, J. L., Salas-Ortiz, A., Banda, L. M., Olawo, A., ... & Bautista-Arredondo, S. (2023). Estimating the cost of HIV services for key populations provided by the LINKAGES program in Kenya and Malawi. BMC Health Services Research, 23(1), 337.