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Assessing cost and technical efficiency of HIV prevention interventions in sub-Saharan Africa: the ORPHEA study design and methods.

Bautista-Arredondo S, Sosa-Rubí SG, Opuni M, Kwan A, Chaumont C, Coetzee J, Condo J, Dzekedzeke K, Galárraga O, Martinson N, Masiye F, Nsanzimana S, Wamai R, Wang'ombe J, ORPHEA study te - BMC Health Serv Res (2014)

Bottom Line: Robust unit cost estimates are essential for the better use of resources, and information on the heterogeneity in the unit cost of delivering HIV services across facilities - both within and across countries - is critical to identifying and addressing inefficiencies.The study applied a robust methodological design to collect comparable information to estimate the cost of HTC, PMTCT, VMMC, and sex worker prevention services in Kenya, Rwanda, South Africa, and Zambia, the level of efficiency in the current delivery of these services, and the key determinants of efficiency.The results of the study will be important to decision makers in the study countries as well as those in countries facing similar circumstances and contexts.

View Article: PubMed Central - PubMed

Affiliation: National Institute of Public Health (INSP), Division of Health Economics, Cuernavaca, Mexico. sbautista@insp.mx.

ABSTRACT

Background: Scaling up services to achieve HIV targets will require that countries optimize the use of available funding. Robust unit cost estimates are essential for the better use of resources, and information on the heterogeneity in the unit cost of delivering HIV services across facilities - both within and across countries - is critical to identifying and addressing inefficiencies. There is limited information on the unit cost of HIV prevention services in sub-Saharan Africa and information on the heterogeneity within and across countries and determinants of this variation is even more scarce. The "Optimizing the Response in Prevention: HIV Efficiency in Africa" (ORPHEA) study aims to add to the empirical body of knowledge on the cost and technical efficiency of HIV prevention services that decision makers can use to inform policy and planning.

Methods/design: ORPHEA is a cross-sectional observational study conducted in 304 service delivery sites in Kenya, Rwanda, South Africa, and Zambia to assess the cost, cost structure, cost variability, and the determinants of efficiency for four HIV interventions: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision (VMMC), and HIV prevention for sex workers. ORPHEA collected information at three levels (district, facility, and individual) on inputs to HIV prevention service production and their prices, outputs produced along the cascade of services, facility-level characteristics and contextual factors, district-level factors likely to influence the performance of facilities as well as the demand for HIV prevention services, and information on process quality for HTC, PMTCT, and VMMC services.

Discussion: ORPHEA is one of the most comprehensive studies on the cost and technical efficiency of HIV prevention interventions to date. The study applied a robust methodological design to collect comparable information to estimate the cost of HTC, PMTCT, VMMC, and sex worker prevention services in Kenya, Rwanda, South Africa, and Zambia, the level of efficiency in the current delivery of these services, and the key determinants of efficiency. The results of the study will be important to decision makers in the study countries as well as those in countries facing similar circumstances and contexts.

No MeSH data available.


Related in: MedlinePlus

Sampling strategy and sample sizes by ORPHEA study component*. *This figure includes all sites visited by the study’s fieldwork teams but excludes facilities initially selected but replaced during fieldwork.
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Fig1: Sampling strategy and sample sizes by ORPHEA study component*. *This figure includes all sites visited by the study’s fieldwork teams but excludes facilities initially selected but replaced during fieldwork.

Mentions: For each country sample, multistage sampling was used to select sub-national areas and health facilities providing HTC, PMTCT, and VMMC. The study team used a number of rigorous and replicable sampling techniques to identify the sub-national areas, the facilities, and the individuals included in the ORPHEA study. Sub-national areas were selected purposively based on local HIV prevalence and other logistical considerations including study staff security (Figure 1).Figure 1


Assessing cost and technical efficiency of HIV prevention interventions in sub-Saharan Africa: the ORPHEA study design and methods.

Bautista-Arredondo S, Sosa-Rubí SG, Opuni M, Kwan A, Chaumont C, Coetzee J, Condo J, Dzekedzeke K, Galárraga O, Martinson N, Masiye F, Nsanzimana S, Wamai R, Wang'ombe J, ORPHEA study te - BMC Health Serv Res (2014)

Sampling strategy and sample sizes by ORPHEA study component*. *This figure includes all sites visited by the study’s fieldwork teams but excludes facilities initially selected but replaced during fieldwork.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4260235&req=5

Fig1: Sampling strategy and sample sizes by ORPHEA study component*. *This figure includes all sites visited by the study’s fieldwork teams but excludes facilities initially selected but replaced during fieldwork.
Mentions: For each country sample, multistage sampling was used to select sub-national areas and health facilities providing HTC, PMTCT, and VMMC. The study team used a number of rigorous and replicable sampling techniques to identify the sub-national areas, the facilities, and the individuals included in the ORPHEA study. Sub-national areas were selected purposively based on local HIV prevalence and other logistical considerations including study staff security (Figure 1).Figure 1

Bottom Line: Robust unit cost estimates are essential for the better use of resources, and information on the heterogeneity in the unit cost of delivering HIV services across facilities - both within and across countries - is critical to identifying and addressing inefficiencies.The study applied a robust methodological design to collect comparable information to estimate the cost of HTC, PMTCT, VMMC, and sex worker prevention services in Kenya, Rwanda, South Africa, and Zambia, the level of efficiency in the current delivery of these services, and the key determinants of efficiency.The results of the study will be important to decision makers in the study countries as well as those in countries facing similar circumstances and contexts.

View Article: PubMed Central - PubMed

Affiliation: National Institute of Public Health (INSP), Division of Health Economics, Cuernavaca, Mexico. sbautista@insp.mx.

ABSTRACT

Background: Scaling up services to achieve HIV targets will require that countries optimize the use of available funding. Robust unit cost estimates are essential for the better use of resources, and information on the heterogeneity in the unit cost of delivering HIV services across facilities - both within and across countries - is critical to identifying and addressing inefficiencies. There is limited information on the unit cost of HIV prevention services in sub-Saharan Africa and information on the heterogeneity within and across countries and determinants of this variation is even more scarce. The "Optimizing the Response in Prevention: HIV Efficiency in Africa" (ORPHEA) study aims to add to the empirical body of knowledge on the cost and technical efficiency of HIV prevention services that decision makers can use to inform policy and planning.

Methods/design: ORPHEA is a cross-sectional observational study conducted in 304 service delivery sites in Kenya, Rwanda, South Africa, and Zambia to assess the cost, cost structure, cost variability, and the determinants of efficiency for four HIV interventions: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision (VMMC), and HIV prevention for sex workers. ORPHEA collected information at three levels (district, facility, and individual) on inputs to HIV prevention service production and their prices, outputs produced along the cascade of services, facility-level characteristics and contextual factors, district-level factors likely to influence the performance of facilities as well as the demand for HIV prevention services, and information on process quality for HTC, PMTCT, and VMMC services.

Discussion: ORPHEA is one of the most comprehensive studies on the cost and technical efficiency of HIV prevention interventions to date. The study applied a robust methodological design to collect comparable information to estimate the cost of HTC, PMTCT, VMMC, and sex worker prevention services in Kenya, Rwanda, South Africa, and Zambia, the level of efficiency in the current delivery of these services, and the key determinants of efficiency. The results of the study will be important to decision makers in the study countries as well as those in countries facing similar circumstances and contexts.

No MeSH data available.


Related in: MedlinePlus