Costs along the service cascades for HIV testing and counselling and prevention of mother-to-child transmission

OBJECTIVE We estimate facility-level average annual cost per client along the HIV testing and counselling (HTC) and prevention of mother-to-child transmission (PMTCT) service cascades. DESIGN Data were collected from 2011-2013 in 230 HTC and 212 PMTCT facilities in Kenya, Rwanda, South Africa, and Zambia. METHODS Input quantities and unit prices were collected, as were output data. Annual economic costs were estimated from the service providers' perspective using micro-costing. Average annual costs per client in 2013 US$ were estimated along the service cascades. RESULTS For HTC, average cost per client tested ranged from US$5 (SD US$7) in Rwanda to US$31 (SD US$24) in South Africa whereas average cost per client diagnosed as HIV-positive ranged from US$122 (SD US$119) in Zambia to US$1,367 (SD US$2,093) in Rwanda. For PMTCT, average cost per client tested ranged from US$18 (SD US$20) in Rwanda to US$89 (SD US$56) in South Africa; average cost per client diagnosed as HIV-positive ranged from US$567 (SD US$417) in Zambia to US$2,021 (SD US$3,210) in Rwanda; average cost per client on antiretroviral (ARV) prophylaxis ranged from US$704 (SD US$610) in South Africa to US$2,314 (SD US$3,204) in Rwanda; and average cost per infant on nevirapine (NVP) ranged from US$888 (SD US$884) in South Africa to US$2,359 (SD US$3,257) in Rwanda. CONCLUSIONS We found important differences in unit costs along the HTC and PMTCT service cascades within and between countries suggesting that more efficient delivery of these services is possible.