The costs of scaling up HIV prevention for high risk groups: lessons learned from the Avahan Programme in India.

OBJECTIVE: The study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond. DESIGN: Prospective costing study. METHODS: This study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$2011. RESULTS: Mean total unit costs (2004-08) per person reached at least once a year and per monthly contact were US$ 235(56-1864) and US$82(12-969) respectively. 35$ 477 per person reached in 2004 to US$145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached. CONCLUSIONS: Scaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities

Setting description.^*

<p><b>*Source:</b> NACO (2012). "Technical report India HIV estimates."</p><p>**includes both <i>Avahan</i> and Non-<i>Avahan</i> districts. Source: Avahan.</p><p>Setting description.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0106582#nt101" target="_blank">*</a>}</p

Outputs and unit costs by service level 2004-08, US$ 2011.

<p>*Persons reached includes individuals contacted at least once a year.</p><p>** Sums the number of persons contacted at least once each month for all months in the year.</p><p>***Intensity is the number of monthly contacts per person reached.</p><p>Outputs and unit costs by service level 2004-08, US$ 2011.</p

Total economic costs by organizational level and activity 2004 to 2008 (US$ 2011).

<p>* 2 NGOs excluded.</p><p>Total economic costs by organizational level and activity 2004 to 2008 (US$ 2011).</p