title: The costs of HIV prevention for different target populations in Mumbai, Thane and Bangalore.
abstract: BACKGROUND
  Avahan, the India AIDS Initiative, delivers HIV prevention services to high-risk populations at scale. Although the broad costs of such HIV interventions are known, to-date there has been little data available on the comparative costs of reaching different target groups, including female sex workers (FSWs), replace with 'high risk men who have sex with men (HR-MSM) and trans-genders.
  
  
  METHODS
  Costs are estimated for the first three years of Avahan scale up differentiated by typology of female sex workers (brothel, street, home, lodge based, bar based), HR-MSM and transgenders in urban districts in India: Mumbai and Thane in Maharashtra and Bangalore in Karnataka. Financial and economic costs were collected prospectively from a provider perspective. Outputs were measured using data collected by the Avahan programme. Costs are presented in US$2008.
  
  
  RESULTS
  Costs were found to vary substantially by target group. Non-governmental organisations (NGOs) working with transgender populations had a higher mean cost (US $116) per person reached compared to those dealing primarily with FSWs (US $75-96) and MSWs (US $90) by the end of year three of the programme in Mumbai. The mean cost of delivering the intervention to HR-MSMs (US $42) was higher than delivering it to FSWs (US $37) in Bangalore. The package of services delivered to each target group was similar, and our results suggest that cost variation is related to the target population size, the intensity of the programme (in terms of number of contacts made per year) and a number of specific issues related to each target group.
  
  
  CONCLUSIONS
  Based on our data policy makers and program managers need to consider the ease of accessing high risk population when planning and budgeting for HIV prevention services for these populations and avoid funding programmes on the basis of target population size alone.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. sudha.chandrashekar@lshtm.ac.uk
authors.forename: Sudha
authors.initials: S
authors.lastname: Chandrashekar
authors.forename: Anna
authors.initials: A
authors.lastname: Vassall
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Reddy
authors.forename: Govindraj
authors.initials: G
authors.lastname: Shetty
authors.forename: Peter
authors.initials: P
authors.lastname: Vickerman
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000191:economics* / Q000517:prevention & control*; D017048:Health Care Costs; D006293:Health Promotion / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000191:economics* / Q000706:statistics & numerical data; D018451:Homosexuality, Male; D006801:Humans; D007194:India; D008297:Male; D011446:Prospective Studies; D060386:Sex Workers; D014189:Transsexualism; D014505:Urban Population